EP3119287B1 - Apparatus for loading suture - Google Patents
Apparatus for loading suture Download PDFInfo
- Publication number
- EP3119287B1 EP3119287B1 EP14886626.2A EP14886626A EP3119287B1 EP 3119287 B1 EP3119287 B1 EP 3119287B1 EP 14886626 A EP14886626 A EP 14886626A EP 3119287 B1 EP3119287 B1 EP 3119287B1
- Authority
- EP
- European Patent Office
- Prior art keywords
- suture
- suturing instrument
- cartridge
- seat
- instrument
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Images
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/062—Needle manipulators
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00526—Methods of manufacturing
- A61B2017/0053—Loading magazines or sutures into applying tools
Definitions
- the disclosure relates to a suturing kit.
- the cartridge defines a path for insertion thereto and withdrawal therefrom of the suturing instrument.
- the cartridge further comprises a seat for releasably holding a portion of a suture and a mechanism for transferring the suture from seat to the suturing instrument, various features of which are described herein.
- examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge defining a path for insertion thereto and withdrawal therefrom of the suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture; and a translation mechanism for moving the seat out of a path of a suturing instrument inserted into the cartridge to allow for withdrawal of the suturing instrument from the cartridge.
- examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture; and an alignment feature for facilitating alignment of the seat with a suturing instrument to permit transfer of the suture portion from the seat onto the suturing instrument.
- examples provide a cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for holding a portion of the suture; and an instrument retention mechanism configured to allow advancement of a suturing instrument into the cartridge and to prevent premature retraction therefrom.
- a cartridge for loading a suture onto a suturing instrument comprising: a seat for releasably holding a portion of a suture to enable transfer of the suture onto the suturing instrument; and an indicator for indicating transfer of the suture portion onto the suturing instrument.
- a cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for holding a portion of a suture; and an obstructing feature having a closed configuration and an open configuration, the obstructing feature being configured to be initially in the closed configuration for preventing advancement of an inverted suturing instrument into the cartridge, and to be moveable into the open configuration upon insertion of the suturing instrument into the cartridge in a nominal orientation.
- examples of a cartridge for loading suture onto a suturing instrument comprising: a seat for releasably holding a portion of the suture; an alignment feature for aligning the seat with a portion of the suturing instrument; a suture insertion mechanism that is actuatable to insert the suture portion from the seat onto the suturing instrument; and a delay interlock to prevent actuation of the suture insertion mechanism prior to alignment of the seat with the portion of the suturing instrument.
- examples provide a cartridge for loading a pre-tied knot onto a suturing instrument, the cartridge comprising: a cartridge housing; a knot slider for carrying a pre-tied knot thereabout; and a knot slider release mechanism for detachably coupling the knot slider to the cartridge housing.
- examples of the present invention provide a cartridge for a cartridge for loading suture onto a suturing instrument comprising a suture passing member, the cartridge comprising a seat for holding an end of the suture, the seat being structured and configured to allow a suture passing member to be advanced over the suture end to capture the suture end.
- kits generally including at least one cartridge as described hereinbelow, along with at least one suturing instrument, the cartridge being operable in cooperation with the suturing instrument to load suture from the cartridge onto the instrument.
- a suturing instrument may be used by physicians to pass suture through a region of tissue having a cut or a defect in order to approximate the tissue to repair the defect.
- it may be difficult to load the suture using conventional loading mechanisms as they may require the user to perform several steps, may require user dexterity, concentration and a specific order of operation which if done out of order could result in a failure of the device and may be time consuming.
- a cartridge for loading suture onto a suturing instrument at the point of use that provides ease of use and which allows the suture to be loaded in an efficient manner.
- a cartridge that permits loading of a suture onto a suturing instrument upon axial or linear movement of the suturing instrument at least partially through the cartridge.
- the cartridge may additionally comprise one or more features that facilitate alignment and transferring of the suture onto the instrument.
- some examples provide a suture cartridge that is usable for loading suture onto a medical device such as a surgical suturing instrument at the point of use in a situation where suture is to be supplied separate from the device.
- a cartridge is provided that allows the physician to load the suture onto a surgical suturing instrument prior to a surgical procedure using an axial or front end loading mechanism.
- the cartridge defines a seat for holding a portion of the suture and defines an opening extending longitudinally through at least a portion of the cartridge, which allows a portion of the surgical suturing instrument to be received axially there-through for aligning a portion of the suture held therein with the surgical suturing instrument. This allows direct transfer of the portion of the suture held within the seat from the cartridge onto the surgical suturing instrument, allowing it to be independently transferred to enable the surgical suturing instrument to suture therewith.
- the cartridge may additionally comprise one or more features that facilitate transferring or loading the suture onto the device.
- the cartridge additionally provides one or more of: a means to mount a pre-tied knot onto the surgical instrument, a restraint to secure a position of the suturing instrument upon insertion into the cartridge, and an alignment feature to align the suture with the suturing instrument, such as a moveable seat.
- a cartridge is provided that is usable with a suturing instrument that defines a tissue receiving gap, where the cartridge is configured to position the seat within the tissue receiving gap to facilitate alignment of the portion of the suture held within the seat with a suture passing member of the suturing instrument.
- Certain examples thereby provide a suture cartridge for loading suture onto a suturing instrument, for example at a point of use, by efficiently aligning the suture with the suturing instrument.
- the cartridge additionally provides one or more of a means to load a pre-tied knot onto a suturing instrument and a means for transferring the suture onto the suturing instrument.
- a suture carrying cartridge for loading a surgical suturing instrument such as a suture passer at the point of use (where the suturing instrument requires a pre-tied knot and comprises a suture passing member, and where loading involves loading the suture onto the suture passing member and loading the pre-tied knot onto the surgical suturing instrument).
- the suture carrying cartridge (having a pre-tied knot secured thereto) is coupled to the suture passer and allows coupling of the suture to the suture passing member by allowing the suture to be moved so that it is aligned with the suture passing member.
- Fig. 1A further illustrates a cartridge 100 in accordance with an example.
- the cartridge 100 is provided for loading a length of suture 500 onto a surgical suturing instrument including loading a pre-tied knot 502 comprising suture loops (which in some examples is formed from and/or attached to the suture 500) onto the suturing instrument.
- the suture 500 may define an end portion 504 (of the suture (or suture end) 504, such as a knot 504'), for loading onto the surgical suturing instrument 900.
- Fig. 1A further illustrates a cartridge 100 in accordance with an example.
- the cartridge 100 is provided for loading a length of suture 500 onto a surgical suturing instrument including loading a pre-tied knot 502 comprising suture loops (which in some examples is formed from and/or attached to the suture 500) onto the suturing instrument.
- the suture 500 may define an end portion 504 (of the suture (or suture end) 504, such as a knot 504'),
- the suture 500 emanating from the pre-tied knot 502 terminates in two strands of suture: a service loop 501 terminating in tug loop 507 that is connected to the suture end 504, and a locker 503.
- the surgical suturing instrument is of the type defining a suture passing member defining a suture receiving passage therein for receiving the end portion 504 of the suture 500 from the cartridge 100.
- the surgical suturing Instrument or suturing instrument 900 is of the type having an instrument proximal portion (or shaft) 910 and an instrument distal portion 920 coupled thereto via a neck portion 940 and defining a tissue receiving gap 942 there-between.
- the instrument distal portion 920 may alternatively be referred to as the distal end or distal tip 920.
- the suturing instrument 900 comprises a suture passing member 930 such as a hollow needle 930' housed within the instrument proximal portion 910, the suture passing member 930 defining a suture receiving passage 932 for receiving the end portion 504 of the suture.
- the suture passing member 930 is reciprocally movable for example, between the device proximal portion 910 and the device distal portion 920. In some examples movement of the suture passing member 930may assist in transferring the suture end portion 504 from the cartridge 100 to the suturing instrument 900.
- the suturing instrument 900 is of the type shown and described in the PCT application: PCT/IB2012/054204 .
- a cartridge 100 is shown for loading suture 500 onto the surgical suturing instrument 900.
- the cartridge 100 comprises a housing 10' defining a chamber 10 for receiving the surgical suturing instrument 900.
- the cartridge further comprises a base 120 coupled to the chamber 10.
- the chamber 10 comprises a means for securing or mounting the pre-tied knot 502 about the chamber 10.
- the means for securing the pre-tied knot 502 comprises a mount 12 for holding the pre-tied knot 502 about the chamber 10. More specifically, the mount 12 may form a part of the housing 10'. Additionally, the chamber 10 defines a channel to allow a portion of the suturing instrument 900 to be received through the pre-tied knot 502 to enable the pre-tied knot 502 to be deployed thereon.
- the base 120 defines a seat 122 for releasably holding a portion of a suture 500, such as an end 504 of the suture 500.
- the seat 122 defines a seat channel (recess or passage) 124 for retaining the suture end 504. More specifically, the cartridge 100 specifies a seat 122 for 'directly holding' the end 504 of the suture 500 such the suture 500 by itself is held directly by the seat 122.
- the cartridge 100 is structured to allow the seat 122 to be brought into alignment with and in some examples adjacent the suture receiving passage 932 of the suture passing member 930.
- the seat 122 is moveable (along with the base 120) relative to the chamber 10 and housing 10' to bring the suture end 504 into alignment with the suture receiving passage 932.
- the cartridge 100 includes an alignment feature that restrains or fixes/locks the position of the suturing instrument 900 relative to the cartridge to help align the seat 122 with suture receiving passage 932 of the of the suture passing member 930 such as a needle 930'.
- the cartridge base 120 comprises a restraint 25 (means for restraining) for positioning a portion of the suturing instrument 900 received through the chamber 10 relative to the seat 122 for aligning the seat 122 with a suture receiving passage 932 of the suture passing member 930.
- the restraint may function as a means for locking or snapping the cartridge 100 onto the suturing instrument, such as a locking feature.
- the restraint 25 comprises a recess that functions as a locking recess 125 for receiving a portion of the surgical suturing instrument 900.
- the locking recess 125 receives the suturing instrument 900 and allows the base 120 of the cartridge 100 to be latched onto the suturing instrument 900.
- the locking recess 125 within the base 120 receives a portion of the surgical suturing instrument 900 (neck portion 940 and sections of the proximal and distal portions 910, 920) such that the base 120 press-fits around the portion of the suturing instrument 900, to lock the position of the surgical suturing instrument 900 relative to the base 120.
- the cartridge 100 additionally comprises an alignment feature in the form of an alignment recess 130 located adjacent the seat 122.
- the alignment recess 130 is sized to allow the suture passing member 930 to be advanced therein to allow the suture receiving passage 932 to be aligned with the seat 122.
- the alignment recess 130 additionally comprises a bevel face 134 that matches the bevel face 934 of the needle 930' to further assist in aligning the needle 930' with the seat 122.
- the alignment recess 130 receives a portion of the suture passing member 930 such as needle 930' when it is advanced distally to allow the suture receiving passage 932 to be placed in line with the suture end 504 held within the seat 122.
- the alignment recess 130 allows the seat 122 to be brought adjacent and in communication with the suture receiving passage 932 to allow the suture end 504 to be transferred into the lumen of the suture passing member 930.
- the cartridge may additionally comprise features to assist in routing of the suture 500 to facilitate manipulation of the suture 500 in order to transfer the suture 500 from the cartridge 100 to the surgical suturing instrument 900.
- the base 120 of the cartridge 100 further defines a base channel or base slot 128 in communication with the seat 122 for routing the suture 500 to facilitate manipulation of the suture 500 in order to load the suture 500 onto/within the suture passing member 930.
- the base slot 128 may be aligned with a longitudinal opening 928 within the suturing instrument 900 (for example, within the instrument proximal portion 910).
- the suture passing member 930 may also comprise a slit 938 that can line up with the base slot 128 so that it is in communication with the base slot 128. This facilitates loading of the suture 500 into the suture receiving passage 932 by allowing room for suture 500 to exit the cartridge 100, so that it may be manipulated, for example by tugging on the suture 500 to allow it to be transferred from the seat 122 to within the suture passing member 930.
- the cartridge 100 may comprise a base 120 that is formed integrally with the chamber 10 or housing 10'.
- the base 120 may be detachably coupled to the housing 10' via a detachable coupling 50, as shown in Fig. 1A . This may allow the base 120 to be decoupled to from the housing 10' after suture end 504 is loaded into a suturing instrument using the cartridge 100.
- the housing 10' may then be advanced or slid proximally to position the housing 10' and pre-tied knot 502 thereon along the instrument proximal portion, to permit deployment of the pre-tied knot 502 after the suturing instrument is used to apply suture to a region of tissue (such as an inter-vertebral disc) to help secure the suture 500 within the region of tissue.
- a region of tissue such as an inter-vertebral disc
- the base 120 is indirectly coupled to the housing 10' through a flexible coupling 150 such as a flexible tube or tether 152.
- a first end of the flexible tube 152 may be affixed permanently to one of the base 120 and the housing 10', whereas the a second end of the flexible tube 152 may be removably attached to the other of the base 120 and the housing 10'.
- one end of the flexible tube 152 is permanently secured to the base 120 within the base slot 128 and the second end of the flexible tube 152 is received within a groove 16 within the housing 10' to be removably attached thereto.
- both ends of the flexible tube 152 could be permanently affixed to each of the base 120 and the housing 10' and the flexible tube 152 may be designed with break lines to allow separation of the flexible tube 152 into two parts under application of force, allowing detachment of the base 120 from the housing 10'.
- the flexible coupling 150 may comprise a flexible or soft hinge.
- the base 120 may be directly coupled to the housing 10'.
- the cartridge 100 may additionally comprise a means to store the length of suture 500 such as suture storage 60, shown in Fig. 1B .
- the suture storage 60 may comprise one or more spools 160 held within the cartridge 100 to store the length of suture 500. More specifically, the one or more spools 160 may be held within the housing 10' to store the service loop 501 and the locker 503 of the suture 500. The one or more spools 160 may help prevent entanglement of the suture 500 during loading of the suturing instrument 900 and/or during use of the suturing instrument 900. Alternatively, the suture 500 may be held within suture payout tubes..
- the cartridge 100 comprises a suture retaining component 65 such as a suture retaining pin 165 for retaining a portion of the suture 500 to allow the tug loop 507 of the suture 500 to be pulled (to transfer the suture end 504 within the suture receiving passage 932 of the suture passing member 930) while minimizing or preventing force from being applied to the service loop 501. This may help prevent the service loop 501 from being pulled out prematurely from the suture storage 60.
- a suture retaining component 65 such as a suture retaining pin 165 for retaining a portion of the suture 500 to allow the tug loop 507 of the suture 500 to be pulled (to transfer the suture end 504 within the suture receiving passage 932 of the suture passing member 930) while minimizing or preventing force from being applied to the service loop 501. This may help prevent the service loop 501 from being pulled out prematurely from the suture storage 60.
- the suture retention pin 165 is releasable which allows the housing 10' (and thus chamber 10) to be advanced independently from the base 120 proximally along the proximal portion 910 of the surgical suturing instrument 900 in order to place the housing 10' in a position for deployment of the pre-tied knot 502 carried thereon.
- a cartridge 400 is disclosed. Similar to cartridge 300, cartridge 400 provides a seat 422 that is moveable relative to the chamber 10 (housing 10'). Additionally, cartridge 400 incorporates a seat 422 that is automatically moveable.
- a cartridge 400 comprising a cartridge base 420 that is coupled to a housing, for example a housing 10' of the type discussed previously herein above.
- the base 420 may be detachably coupled to the housing 10' (chamber 10).
- Base 420 comprises a magazine 421 which defines the seat 422 for releasably holding or retaining the suture end 504. More specifically, the magazine 421 comprises a projection 430 which defines the seat 422.
- the seat 422 comprises a seat channel 424 and the suture end 504 is press-fit within the seat channel.
- the cartridge 400 comprises an alignment feature in the form of a restraint 25 comprising an instrument receiving recess or locking recess 425' that allows the suturing instrument 900 to be positioned within the base 420 to allow the seat 422 to be aligned with the suture receiving passage 932.
- the alignment comprises a moveable seat 422.
- the magazine 421 is mounted onto a spring 426 forming a spring biased interlock 421' which is automatically moveable upon advancement of the surgical suturing instrument 900 within an instrument receiving recess 425' of the base 420. Movement of the interlock 421' translates into a movement of the projection 430 defining the seat 422.
- the seat 422 is moveable upon advancement of the suturing instrument 900 to bring the suture into alignment with the suture receiving passage 932.
- the magazine 421 comprises a spring biased translation mechanism.
- the spring biased interlock 421' is shown in its initial position 421A.
- the interlock 421' is moveable from its first or initial position 421A into its second position 421B upon advancement of the suturing instrument 900 within the instrument receiving recess 425'. Movement or depression of the interlock 421' into its second position 421B allows the seat 422 to be brought into alignment with the suture passing member 930 and the suture receiving passage 932.
- the interlock 421' comprises a ramp 423 (shown in Figs.
- cartridge base 420 comprises a projection 430 that defines the seat 422.
- the projection 430 extends into the instrument receiving recess 425' and defines an alignment feature.
- the projection 430 is capable of abutting against/mating with the suture passing member 930 such as needle 930' when brought into engagement therewith.
- the magazine 421 moves downwards into the tissue receiving gap.
- Magazine 421 and thus projection 430 and the seat 422 it defines, all move proximally with respect to the suturing instrument 900, so that the projection 430 abuts against the needle 930' to align the seat 422 with the suture receiving passage 932. More specifically, the projection 930 abuts against the needle 930' to co-operatively engage with and align the needle 930' to bring the seat 422 into alignment with the suture receiving passage 932. The seat 422 is brought into communication with the suture receiving passage 932.
- the projection 430 defines a bevel face 434 for engaging with a bevel face 934 of the needle 930' for docking the needle 930' to align the needle 930' with the seat 222 to permit transfer of the suture end 504 from the seat 222 into the suture receiving passage 932 of the needle 930' for example by pulling on the tug loop 507.
- the suture end 504 may be transferred automatically from the seat 422 into the suture receiving passage 932 for example using a plunger.
- the cartridge 400 may comprise a mechanism to permit automatic decoupling of the cartridge base from the suturing instrument 900 and/or the housing 10'.
- the spring biased interlock 421' is capable of automatically returning from its second position 421B (shown in Fig. 2C ) to its original position 421A (shown in Fig. 2A ) to permit de-coupling of the base 420 from the suturing instrument 900 and/or housing 10' (chamber 10).
- a cartridge 1000 for loading suture onto a surgical suturing instrument, for example a suturing instrument 900 as discussed previously herein above with reference to Fig. 1E .
- the cartridge 1000 carries suture therein and functions to align the suture with the suturing instrument 900 upon insertion and axial advancement of the suturing instrument 900 within the cartridge 1000, in order to allow transfer of suture onto the surgical suturing instrument 900.
- the cartridge 1000 additionally functions to transfer the suture onto the suturing instrument 900.
- a cartridge 1000 is provided that is functional to carry suture for loading onto a surgical suturing instrument 900.
- the cartridge comprises a housing 1010' that defines a chamber for axially receiving the surgical suturing instrument 900.
- the chamber 1010 includes a recess or channel that is a part of the chamber 1010 that receives the suturing instrument 900.
- the channel may be referred to as a channel or a recess.
- the chamber 1010 defines a channel for receiving the suturing instrument.
- the cartridge further comprises a base 1020 that is detachably coupled to the housing 1010' that defines a seat for releasably holding the suture therein and enables alignment of the suture with the suture passing member 930 of the suturing instrument 900.
- the housing 1010' additionally comprises a means to secure a portion of the suture thereto and is detachable from the base 1020 to function as a suture transferring component to transfer suture from the cartridge onto the suturing instrument 900.
- the base 1020 and the housing 1010' comprise separate components of the cartridge 1000 that are coupled to one another to assist in loading suture and may be detachable therefrom to assist in transferring suture.
- the housing 1010' may be integrally formed with the base 1020.
- the base 1020 may be formed from two halves 1020a and 1020b, and the housing similarly may also be formed from two halves 1010'a and 1010'b.
- the housing 1010' and the base 1020 collectively provide alignment features to assist in alignment of the suture upon loading of the cartridge 1000 onto the suturing instrument 900 to facilitate transfer of suture from the cartridge 1000 onto the suturing instrument 900 using the suture transferring component.
- the detailed mechanism and operation of the base 1020 and the housing 1010' in aligning and transferring the suture are described further herein below.
- the housing 1010' of the cartridge defines a chamber 1010 that comprises a channel 1014 for receiving the suturing instrument there-through.
- the channel 1014 comprises a proximal opening 1016 that narrows towards the interior of the cartridge housing 1010' as defined by a beveled interior edge 1016'.
- the beveled interior edge 1016' functions as a lead in to guide the suturing instrument 900 into the channel 1014.
- the channel 1014 extends longitudinally through the housing 1010' and is in communication with a recess 1025 that defines an instrument receiving recess or locking recess] formed within the base 1020.
- the channel 1014 may be formed continuously with the recess 1025 within the cartridge base 1020.
- the channel 1014 defines an opening through which the suturing instrument 900 may be advanced though the housing 1010' into the base 1020.
- the channel 1014 and the recess 1025 each function as a restraint 25 to constrain or restrict the lateral and transverse movement of the suturing instrument 900 within the cartridge 1000 while allowing the suturing instrument 900 to be advanced linearly or axially therein in sliding engagement to maintain the position of the suturing instrument 900 along the longitudinal axis as it is advanced.
- the restraint 25 constraints or limits the movement of the suturing instrument 900 in the transverse and lateral directions as well along a longitudinal path defined thereby.
- the restraint 25 facilitates alignment of the suturing instrument 900 with a portion of the suture 500 that is held within a seat 1022 defined by the base 10207 More specifically, the channel 1014 and the recess 1025 allow the suturing instrument 900 to be advanced therein in sliding engagement therein and additionally function to restrain the suturing instrument 900 in a linear path as it is advanced along the cartridge 1000 to allow the seat 1022 to be aligned with the suture receiving passage 932 of the suture passing member.
- the cartridge 1000 comprises an alignment feature in the form of a restraint 25 that comprises an instrument receiving recess defined by channel 1014 and recess 1025, which allow the suturing instrument 900 to be positioned within the base 1020 to allow the seat 1022 holding a portion of the suture to be aligned with the suture passing member 930 of the suturing instrument 900.
- the recess 1025 within the base is formed from two grooves, an instrument receiving groove 1025a defining an instrument receiving recess and a suture receiving groove 1025b defining a suture receiving recess, as shown in Fig. 3F .
- the instrument and suture receiving grooves 1025a and 1025b respectively are formed within the opposing halves 1020a and 1020b of the base 1020 (also illustrated in Fig. 3B ).
- the instrument receiving groove 1025a provides a track which functions as a restraint 25 to allow the suturing instrument 900 to be advanced therein
- suture groove 1025b provides a track to guide the portion of the suture held within the seat into the suture passing member 930 of the suturing instrument 900 by maintaining/routing the suture 500 therein such that it is adjacent and in line with the shaft or proximal portion 910 of the suturing instrument 900 that is receivable within the instrument receiving groove 1025a as further illustrated in Fig. 3E .
- the suture receiving groove 1025b allows the suture to be routed such that when the suturing instrument is received within the instrument receiving recess 1025b, the suture 500 is held adjacent the groove 928 within the shaft or the instrument proximal portion 910 as well groove 938 within suture passing member 930 such as needle 930' (shown in Fig. IE). Furthermore, the groove 1025b provides room for routing the suture without excess tension being placed in the suture by providing a wider opening into a rocker recess 1027 as shown by Figs. 3D and 4A .
- the groove 1025b accommodates as it enters a rocker recess 1027 in both a final position 1041B as well as an initial position 1041A of a rocker 1041 (Discussed further herein below).
- the suture receiving groove 1025b enables the suture 500 to be maintained out of the way of the advancing suturing instrument 900 during use of the cartridge 1000.
- recess groove 1025b is in line with grooves 928, 938 within the suturing instrument 900 to further facilitate transfer of suture from the seat 1022 within the base 1020 into the needle 930'.
- both the instrument receiving groove and the suture receiving groove exit into the rocker recess 1027.
- the cartridge 1000 additionally provides an alignment feature comprising a moveable seat 1022.
- the cartridge 1000 comprises a magazine 1021 that is defined by the base 1020 that functions to align the suture with a portion of the surgical suturing instrument 900 that is receivable within the cartridge 1000.
- the magazine 1021 defines the seat 1022 for releasably holding or retaining a portion of the suture 500. More specifically, the seat 1022 is configured to hold an end portion 504 of the suture 500 as shown.
- the magazine 1021 is moveable with respect to the cartridge 1000 and as such defines a moveable seat 1022 for aligning the suture end 504 held therein with a portion of the surgical suturing instrument 900 that is received within the cartridge 1000. More particularly, as shown in Fig. 3C , the seat 1022 is moveable with respect to the base 1020. (Alternatively, in some examples the seat 1022 may be moveable relative to the chamber 1010 defined by housing 1010', for example in examples where the base 1020 may be formed integrally with the housing 1010' forming a unitary cartridge 1000).
- the seat 1022 is automatically moveable upon insertion of the suturing instrument 900 within the cartridge 1000.
- the magazine 1021 comprises a rocker 1041 that is rotatable about a pivot 1042, and the base 1020 defines a rocker recess 1027 for enabling pivotal movement of the rocker 1041 therein.
- the pivot 1042 is formed by laterally extending pins 1043 of the rocker 1041 (also illustrated in 3G) that are held within pivot support openings 1023 of the base 1020 and are moveable freely therein.
- the rocker 1041 is moveable about the pivot 1042 from its initial position 1041A (as shown in Fig. 3C ) to its second position (as shown in Fig. 4C(i) ) in order to align the seat 1022 and the suture end 504 held therein with the path of an advancing suturing instrument 900 that is inserted within the cartridge 1000.
- the rocker 1041 is held in its initial position 1041A within the rocker recess 1027 through frictional engagement.
- the rocker 1041 may be kept in its initial position 1041A by an engagement feature such as a raised tab or detent [not shown] that is formed within the base 1020 and may extend or juts into the rocker recess 1027.
- the tab may be engageable with a portion of the rocker 1041 to maintain the rocker in its initial position 1041A during shipment and prior to use.
- the rocker 1041 may be held in its initial position 1041A through frictional engagement via a spring based mechanism.
- the frictional force may be sufficient to keep the rocker 1041 in its initial position 1041A when the cartridge is empty, but maybe overcome upon contact with the suturing instrument 900.
- the rocker 1041 may be released from engagement with the base 1020 upon advancement of the suturing instrument 900 within the cartridge 1000 allowing the rocker 1041 to move into its second position 1041B to align the portion of the suture held therein with a portion of the suturing instrument 900.
- the rocker 1041 moves into a cavity defined by the rocker recess 1027. More specifically, as defined herein the rocker 1041 is moveable into a rocker cavity 1027' of the rocker recess 1027 to align the seat 1022 with the suturing instrument 900.
- the rocker cavity 1027' is defined as a portion of the rocker recess 1027 that corresponds to a tissue receiving gap 942 of the suturing instrument 900, upon loading of the cartridge 1000 onto the suturing instrument 900 [ Fig. 3C ].
- the cartridge may comprise additional features that assist in aligning the seat 1022 with a portion of the suturing instrument 900 as the suture passing member 930 held within the shaft or instrument proximal portion or shaft 910.
- the rocker 1041 additionally defines an instrument receiving or locking recess defined by a groove 1044 that is designed for receiving the suturing instrument 900 as it is advanced distally.
- the groove 1044 functions as a restrain to position the suturing instrument 900 in a desired position relative to the seat 1022 to assist in aligning the seat 1022 with a suture passing instrument 900.
- the groove 1044 enables the rocker 1041 to pivot down into its second position 1041B while allowing the suturing instrument 900 to be advanced into the cartridge 1000 to permit loading the suture into the suturing instrument 900.
- the operation of the groove 1044 is discussed further herein below with reference to Figs. 4A-4D that illustrate the operation of the device].
- the groove 1044 comprises a groove proximal portion 1046 for receiving the instrument proximal portion or shaft 910 of the suturing instrument 900, and additionally comprises a groove distal portion 1048 for receiving the instrument distal portion or tip 920.
- the rocker 1041 comprises a median 1047 that is defined by the groove 1044.
- the groove proximal and distal portions 1048, 1048 are separated by the median 1047 functions to hold or define the seat 1022 to enable the seat to be brought down into the tissue receiving gap 942.
- the median 1047 functions as an alignment feature by holding and aligning the seat 1022 with the suture passing member such as needle 930' of the suturing instrument 900. As such median 1047 functions to holding the seat to enable the seat 1022 to be brought down into the cavity 1027'corresponding to the tissue receiving gap upon reception to the suturing instrument within the cartridge.
- the groove 1044 defines an additional alignment feature in the form of an interior bevel face 1043 that is defined by the groove distal portion 1048 of the rocker 1041, along a distal end thereof.
- the bevel 1043 enables the distal portion 920 of the suturing instrument to pivot the rocker 1041 from its initial position 1041A into its aligned position or second position 1041B to enable alignment of the seat 1022 and the suture held therein with the suture passing member 930 of the suturing instrument.
- the rocker 1041 additionally defines another alignment feature in the form of a slot 1049 (as shown in Figs. 3J ) and 3L within the groove 1044 to assist in alignment and transfer of the suture end 504 into the suture passing member 930.
- the slot 1049 comprises a slit or channel 1049a that is formed within a wall 1044' of the rocker 1044 and extends transversally along the base of the wall 1044' to route the suture there-through upon exiting the seat 1022.
- the slit or channel 1049a functions to retain the suture 500 therein as it exits the seat 1022 within the rocker 1041 to aid in routing the suture 500 within the suture receiving groove 1025b ( Fig.
- the slit or channel 1049 exists into a cut-out portion defined within the exterior wall of the rocker 1041.
- the cutout defines a side slot 1049b defining a space enabling the suture 500 to be routed there-through to be guided into the suture receiving groove 1025b of the base 1020.
- the slit or groove 1049a is in communication with the rocker side slot 1049b to hold the suture to the side within the suture receiving groove 1025b of the base. This allows the suture to be held to the side of the suturing instrument 900 during advancement of the suturing instrument within the cartridge base 1020.
- the seat 1022 is defined by a projection 1030 that is housed within the magazine 1021, specifically within the rocker 1044.
- the median 1047 comprises an axially extending channel or opening therein for receiving and retaining a projection 1030 that defines the seat 1022.
- the projection may be press-fit within the channel or opening. In other examples it may be coupled to the median using an adhesive.
- the projection 1030 defining the seat 1022 may be formed in one piece as part of the rocker.
- the projection 1030 defines a hollow interior forming a seat channel 1024 and the suture end 504 is press-fit within the seat channel 1024 to be held therein.
- the projection 1030 forms an alignment feature to further aid in aligning the seat 1022 with the suture receiving passage 932 of the suture passing member 930 such as the needle 930' within the shaft 910.
- the projection 1030 extends into the instrument receiving recess defined by the groove 1044. More specifically, the projection 1030 is capable of abutting against/mating with the suture passing member 930 (such as needle 930') when brought into engagement therewith.
- the projection 1030 defines a bevel face 1034 for engaging with a bevel face 934 of the needle 930' for docking the needle 930' to align the seat 1022 with the needle 930' with to permit transfer of the suture end 504 from the seat 1022 into a suture receiving passage 932 of the needle 930'.
- the projection 1030 is receivable into the instrument proximal portion or shaft 910 to facilitate alignment of the seat 1022 with the needle 930'.
- the rocker 1041 comprises additional alignment features to assist in alignment of the seat 1022.
- the projection 1030 comprises interference features in the form of raised bumps 1045a on the exterior of the projection 1030 that are configured to frictionally engage the interior of the instrument proximal portion or shaft 910 with the needle 930' as the projection 1030 is received within the shaft 910.
- the rocker 1041 also, as shown in Fig. 3K and 3M , the cartridge 1000 defines a suture groove or slot to allow the suture to exit the seat 1022.
- the rocker 1041 defines a suture slot that is in communication with the seat 1022 for allowing the suture to exit the seat 1022.
- the comprises additional raised bumps 1045b along the interior of the proximal groove portion 1046 for frictionally engaging the exterior of the instrument proximal portion or shaft 910 once it is received within the proximal groove portion 1046 in order to align the seat 1022 with the needle 930'.
- This may be referred to as the needle-in configuration of cartridge 1000 as the needle 930' remains inside the shaft 910 during loading of the suturing instrument 900.
- projection 1030 defines a suture slot 1038 therein allowing the suture 500 to exit therefrom to enable alignment of the suture end 504 with the suture receiving passage 932 within the needle 930'. More specifically, the suture slot 1038 enables the suture to be to be routed through it upon exiting the seat 1022, such that suture is aligned with the needle slot 928 and shaft slot 938. This facilitates transfer of the suture end into the suture receiving passage 932 of the needle 930 using a suture transferring component of the cartridge 1000.
- the suture exits the suture slot 1038 it is routed though the slot 1049 of the rocker 1041 to enable suture be held to the side of the rocker such that it is off to the side of the path of the suturing instrument 900 as it is advanced into the cartridge 1000.
- the magazine for example the rocker 1041, comprises an alignment recess 1030' that is located adjacent the seat, for holding the suture therein.
- the rocker 1041 defines an opening/space or such as a seat recess or seat channel that forms the seat 1022' for holding the suture end 504 in frictional engagement therein.
- the alignment recess 1030' is positioned adjacent the seat 1022' and is in line with the suture passing member 930.
- the alignment recess 1030' is configured for receiving the suture passing member 930 (such as needle 930') therein, to allow suture end 504 to be transferred from the seat 1022' to the suture receiving passage 932 of the suture passing member 930.
- the present configuration of the cartridge 1000 may be referred to as the needle-out configuration as the needle 930' is maintained in a partially extended position during loading of the cartridge 1000 onto the suturing instrument 900, as shown in Fig. 3N .
- a distal portion of the needle 930 extends distally outside the shaft 910 of the suturing instrument at the time of loading the cartridge 1000 onto the suturing instrument.
- the suture passing member 930 such as the needle 930' can be held in a partially extended position to allow the needle 930' to be receiving within the alignment recess 1030' for loading of suture therein.
- a needle lock is provided that is mounted along the instrument proximal portion or shaft 910 of the suturing instrument 900 and is engageable with an aperture 935 within the needle 930' in its locking position to maintain the needle 930' in the partially extended position during loading of the cartridge 1000 onto the suturing instrument 900.
- the needle lock may be disengaged thereafter to allow the needle 930' to be retracted to its nominal position prior to use of the suturing instrument 900.
- the needle lock comprises a cam lock 937 comprising a cam 939 within a cam housing 939'.
- the cam In its locked position 937A as shown, the cam is engaged with the aperture 935 of the needle 930' preventing the needle 930' from retracting into the instrument proximal portion or shaft 910.
- the cam 939 allows the needle 930' to remain in its partially extended position to allow the needle 930' to be received within the alignment recess 1030' of the cartridge 1000 facilitating alignment and transfer of suture end form the seat 1022' into the needle 930'.
- the cam 939 may then be disengaged from the needle aperture 935 thereafter moving the cam lock 937 into its unlocked position which the needle 930' to retract back into the shaft or instrument proximal portion 910.
- a component of the cartridge 1000 for example a component of the cartridge housing 1010' may moveable proximally along the instrument proximal portion of shaft 910 to disengage the cam lock moving it into its unlocked position to allow the needle to move into its unactuated/nominal position.
- the rocker 1041 comprises additional alignment features to assist in alignment of the seat 1022'.
- the alignment recess 1030' adjacent the seat 1022' comprises interference features for frictionally engaging an exterior of the needle 930' of the suturing instrument 900 upon advancement of the needle 930' into the alignment recess 1030'.
- the cartridge 1000 comprises interference features in the form of raised bumps 1045a on the inner surface of the wall defining the alignment recess 1030'.
- the raised bumps 1045a extend proximally along the inner surface of the wall of the alignment recess 1030' and are configured to frictionally engage the exterior of the needle 930' as the needle 930' is received within the alignment recess 1030'.
- the rocker 1041 shown in Fig. 3L also comprises additional raised bumps 1045b along the interior of the proximal groove portion 1046 for frictionally engaging the exterior of the instrument proximal portion or shaft 910 once it is received within the proximal groove portion 1046 in order to align the seat 1022 with the needle 930'.
- This may be referred to as the needle-out configuration of the cartridge 1000 as the needle 930' remains partially extended outside the distal end of the shaft 910, during loading of the cartridge 1000 onto the suturing instrument 900.
- the cartridge 1000 defines a suture groove or slot to allow the suture to exit the seat 1022.
- the rocker 1041 defines a suture slot that is in communication with the seat 1022 for allowing the suture to exit the seat 1022.
- the alignment recess 1030' defines a suture slot 1038' therein allowing the suture 500 to exit therefrom to enable alignment of the suture end 504 with the suture receiving passage 932 within the needle 930'.
- the suture slot 1038' enables the suture to be to be routed through it upon exiting the seat 1022, such that suture is aligned with the needle slot 928 and shaft slot 938. This facilitates transfer of the suture end into the suture receiving passage 932 of the needle 930 using a suture transferring component of the cartridge 1000.
- the suture slot 1038' Once the suture exits the suture slot 1038', it is routed though the slot 1049 of the rocker 1041 to enable suture be held to the side of the rocker such that it is off to the side of the path of the suturing instrument 900 as it is advanced into the cartridge 1000.
- the rocker 1041 additionally comprises interference tabs 1048x (as shown in 9M) for engagement with the suturing instrument 900 which allow the rocker 1041 to over-rotate to ensure alignment of the rocker 1041 with the instrument proximal portion or shaft 910 of the suturing instrument 900 to allow advancement of the rocker 1041 along the shaft 910.
- the interference tabs 1048x may allow the rocker 1041 to rotate sufficiently to enable the seat 1022 to be positioned adjacent the suturing instrument 900 by ensuring that the shaft 910 is received within the rocker groove proximal portion 1046.
- the interference tabs allow the rocker 1041 to rotate sufficiently to enable the projection 1030 to be received within the instrument shaft 910.
- the interference tabs allow the rocker 1041 to rotate sufficiently such that the alignment recess and the seat 1022 adjacent to it are both aligned with the needle 930'.
- some examples define base 1020 that is detachably coupled to the housing 1010' enabling the base 1020 and the housing 1010' to operate as a single unit upon loading of the cartridge 1000 onto the suturing instrument 900 where both the base 1020 and the housing 1010' provide features to assist in alignment of a portion of the suture 500 such as a suture end 504 with the suture passing member 930.
- the housing 1010' additionally comprises a means to frictionally engage a portion of the suture and is detachable from the base 1020 after alignment of the suture portion with the suture passing member 930 to transfer the suture portion into the suture passing member.
- the means to frictionally engage a portion of the suture comprises a suture lock.
- the cartridge housing 1010' defines a suture transferring component 1011 to transfer of the suture end into the suture passing member 930.
- the suture transferring component 1011 is operable to pull the portion of the suture that is held in frictional engagement in order to transfer the suture portion such as suture end 504 held within the seat 1022, onto the suturing instrument 900.
- the cartridge 1000 comprises a suture transferring component 1011 that forms or defines a pull mechanism as described further in the method outlined herein below.
- the pull mechanism is defined as the mechanism of the cartridge that enables a pulling force to be exerted or applied to the suture portion such as the suture end to transfer the suture portion from the seat into the suturing instrument.
- the housing 1010' may additionally comprise suture loops that form a partially pre-tied knot that are mounted about the housing 1010'. Additionally in some examples the housing 1010' may provide a means to house excess suture. In one example, the excess suture may be provided on spools that are carried by housing 1010'.
- the cartridge base 1020 is detachably coupled to the cartridge housing 1010' via an interlock.
- the cartridge housing 1010' defining the suture transferring component 1011 comprises an interlock 1050.
- the interlock 1050 secures the base 1020 to the housing 1010' (and thus the suture transferring component) allowing the cartridge 1000 to operate a single functional unit upon loading of the cartridge 1000 onto the suturing instrument 900, until the seat 1022 is aligned with the suturing passing member 930.
- the interlock 1050 may then be disengaged to allow the housing 1010' that defines the suture transferring component 1011 to translate independently along the suturing instrument 900 to transfer the suture end 504 from the seat 1022 into the suture passing member 930 of the suturing instrument 900.
- Figs.5A-5C illustrate the interlock 1050 in its initial locked position 1050A, with the interlock arms 1056 of the interclock 1050 being axially aligned with the locking arms 1026 of the base.
- the interlock arms 1056 prevent movement of the housing 1010' with respect to the base 1020 to form a cartridge unit 1000 by blocking longitudinal movement of the locking arms 1026 of the base 1020 (and as such block the longitudinal movement of the base 1020).
- the interlock 1050 is moveable into its unlocked position 1050B to allow the housing 1010' to be disengaged from the base 1020.
- the interlock 1050 comprises a manual interlock that is moveable into the unlocked position 1050B to manually disengage the housing 1010' (and thus the suture transferring component 1011 defined thereby) from the base 1020 upon alignment of the seat 1022 with the suture passing member 930.
- suture transferring component defined by the housing 1010' comprises a means to hold a portion of the suture 500 in frictional engagement with the housing 1010' to allow the housing 1010' to move the suture 500 therewith to enable the housing 1010' to transfer the suture end 504 held within the seat 1022 of the base to the suture passing member 930.
- a portion of the suture is held in frictional engagement with a suture lock 1060 to secure the suture 500 thereto to enable the housing to pull the suture end 504 by applying tension to the suture (for example a segment of suture held in frictional engagement within the housing, for example via a suture lock) from the seat 1022 into the suture passing member 930.
- the suture 500 is held within the cartridge 1000 such that the suture 500 is routed from the suture end 504 within the seat 1022 upon exiting the seat slot 1038 such that it enters the slot 1049 of the rocker to be routed there-through. More specifically, in some examples the suture passed through and pinched within the slit or channel 1049 such that it is held therein in a force fit engagement. The suture 500 then enters the side slot 1049b on the exterior face of the rocker 1041 [ Figs 3J and 3L ].
- the suture 500 exits the rocker 1041 into the rocker recess 1027 and is routed through the recess groove 1025b within the base 1020 which allows the suture 500 to be maintained within recess groove 1025b adjacent and out of the way of the path of the suturing instrument 900 to be inserted through the recess groove 1025a [ Fig. 3D ].
- the suture is then routed through an opening 1051 within the interlock and guided into a suture channel 1061 to engage with the suture lock 1060 In one particular embodiment, as shown in Figs.
- the suture lock 1060 comprises projections or teeth 1064 defining contours or ridges and valleys that are configured to engage corresponding features in the form or projections or teeth 1064 within a suture lock engaging component 1062 of the housing 1010'.
- the suture 500 is routed through the suture lock engaging component 1062 of the housing 1010' and the suture lock 1060 is press fit to engage with the suture lock engaging component 1062 pressing the suture between the two, and as such coupling the suture to the housing 1010'.
- Figs. 7B and 7E show the lock in its initial locked configuration 1060A.
- the lock 1060 remains in its locked configuration until the suture portion such as the end of the suture has been loaded into the suturing instrument 900. It is moveable thereafter into its second of unlocked configuration as shown in Figs.7C and 7D and additionally in Fig. 7F to allow the suture 500 to be disengaged from the housing 1010'.
- the movement of the suturing instrument 900 may be a relative movement with respect to the cartridge 1000.
- the user may move the cartridge 1000 axially over the suturing instrument 900 in a proximal direction while the suturing instrument is held by the user in order to create a relative advancement of the suturing instrument 900 with respect to the cartridge 1000 in order to load the suture onto the suturing instrument 900.
- This may be refer to as loading of suture using pumping action.
- the mechanism of loading of the suture may remain as described above but the movement may be created either by the proximal movement of the cartridge over the suturing instrument or the distal movement of the suturing instrument within the cartridge.
- the cartridge is configured to align and transfer the suture upon a single linear motion of the cartridge with respect to the suturing instrument.
- the interlock 1050 may be automatically disengaged upon alignment of the suture end within the seat with the suture passing member to enable automatic transfer of the suture end 504 into the suture passing member as the housing 1010' is continued to be pulled proximally.
- the suture lock 1060 may be automatically disengaged thereafter upon transfer of the suture end from the seat 1022 into the suture passing member 930, which would allow the suturing instrument to be able to pass the suture in order to suture therewith.
- the cartridge is loaded onto the suturing instrument 900 with a single linear movement.
- a single pumping action is used involving a single linear relative movement of the cartridge onto the suturing instrument and removal of the base 1020 [for example via a linear movement in the opposing direction to the loading direction] thereafter leaving the housing coupled to the suturing instrument for example to mount a pre-tied knot held therein onto the suturing instrument.
- a cartridge 2000 for loading suture onto a surgical suturing instrument, for example a suturing instrument 900 as discussed previously herein above with reference to Figs. 1D and 1E .
- the cartridge 2000 carries suture therein and allows suture to be loaded onto a surgical suturing instrument 900 for example, at the point of use.
- the cartridge 2000 functions to align the suture with the suturing instrument 900 upon insertion and relative axial advancement of the suturing instrument 900 within the cartridge 2000, and additionally functions to transfer of the suture onto the surgical suturing instrument 900.
- either the suturing instrument 900 may be advanced distally into the cartridge 2000 or the cartridge 2000 may be pulled proximally over the suturing instrument. As described herein either of these techniques may be utilized to provide the functionally described herein for creating relative axial movement between the cartridge 2000 and the suturing instrument 900 for loading the suture onto the suturing instrument 900. This is also applicable to examples described herein above in example 3.
- the cartridge 2000 additionally provides a pre-tied knot therein and enables the pre-tied knot to be loaded onto the suturing instrument 900.
- the pre-tied knot may comprise loops that substantially form a pre-tied knot.
- a pre-tied knot may comprise a partially pre-tied knot.
- the partially pre-tied knot is configured to be deployed from the suturing instrument after suturing to form a knot to secure the suture.
- the cartridge comprises a housing 2010' that defines a chamber 2010 for axially receiving the surgical suturing instrument 900.
- the cartridge 2000 further comprises a base 2020 that is detachably coupled to the housing 2010', the base 2020 defining a seat 2022 for releasably holding the suture therein [As shown in Fig.8E(ii) ].
- the base 2020 enables alignment of the suture held therein with the suture passing member 930 of the suturing instrument 900.
- the housing 2010' additionally comprises a suture transferring component to transfer suture from the base 2020 onto the surgical suturing instrument 900.
- the base 2020 and the housing 2010' comprise separate components of the cartridge 2000 that are coupled to one another to assist in loading suture and may be detachable therefrom to assist in transferring suture.
- the housing 2010' additionally comprises a chamber 2010 therein and a means for securing or mounting a pre-tied knot 502 about the chamber 2010, to enable the pre-tied knot to be mounted onto the suturing instrument 900.
- the housing 2010' and the base 2020 collectively provide alignment features to assist in alignment of the suture upon loading of the cartridge 2000 onto the suturing instrument 900 to facilitate transfer of suture from the cartridge 1000 onto the suturing instrument 900 using the suture transferring component.
- the housing 2010' comprises a knot slider 2030 that defines the chamber 2010, the knot slider 2030 includes suture loops coupled thereto, the suture loops are configured to form a knot upon deployment thereof from the knot slider 2030, wherein the suturing instrument 900 is receivable within the chamber 2010 for mounting the suture loops onto the suturing instrument.
- a suturing system comprising a suturing instrument 900 comprising a suture passing member 930; and a cartridge (such as cartridge 2000) for releasably holding an end of a suture and defining a chamber 2010 for coupling a partially pre-tied knot thereabout, the chamber 2010 is configured to receive the suturing instrument 900 therethrough.
- the cartridge 2000 is configured to transfer the suture end 504 into to the suture passing member 930 and to transfer the partially pre-tied knot (for example 502) onto the suturing instrument.
- the suture passing member 930 is configured to pass the suture end 504 from a proximal side of a tissue to a distal side of the tissue in a first actuation of the suture passing member.
- a cartridge (such as cartridge 2000) is provided for loading suture onto a suturing instrument 900 to enable the suturing instrument to form a pre-tied knot
- the cartridge comprises: a chamber 2010 for receiving a suturing instrument 900, the chamber 2010 supporting loops of suture coupled thereto (such as loop 502 shown in Fig.
- the suturing instrument 900 for transferring onto the suturing instrument 900 upon advancement of the suturing instrument into the chamber 2010, the loops 502' of suture being configured to form a pre-tied knot upon deployment from the suturing instrument; and a seat 1022 for releasably holding a portion of the suture to enable transfer of the suture portion 504 onto the suturing instrument, the suture portion comprising an end of the suture configured to define a post of the pre-tied knot upon deployment of the loops from the suturing instrument.
- the cartridge housing 2010' is detachably coupled to the base 2020 and defines a chamber 2010 for receiving the surgical suturing instrument 900 there-through.
- the chamber 2010 additionally comprises a means for storing a pre-tied knot about the chamber.
- the housing 2010' additionally comprises a knot slider 2030 defining the chamber 2010 having a pre-tied knot mounted thereon wherein the surgical suturing instrument is receivable within the chamber 2010 to mount the pre-tied knot onto the surgical suturing instrument 900.
- the cartridge housing 2010' comprises an outer housing sleeve 2011' that defines a hollow interior for holding the knot slider 2030 therein.
- the knot slider 2030 is detachably coupled to the housing sleeve 2011' and forms a part of the housing 2010'.
- the knot slider 2030 is detachably coupled to the housing 2010' via the base 2020 for holding a pre-tied knot about the chamber 2010.
- the chamber 2010 includes a recess or channel 2014 that is a part of the chamber that receives the suturing instrument.
- the chamber 2010 defines a channel 2014 as shown in Fig. 8D which illustrates a rear view of the knot slider 2030 to allow a portion the suturing instrument 900 to be received there-through
- the channel 2014 defines an instrument receiving recess for receiving the suturing instrument 900 that additionally functions as a restraint for maintaining the position of the suturing instrument 900 as it is advanced through the cartridge 2000.
- the channel 2014 comprises a proximal opening 2016 that narrows towards the interior of the knot slider 2030 as defined by a beveled interior edge 2016'.
- the beveled interior edge 2016' functions as a lead in to guide the suturing instrument 900 into the channel 2014.
- the channel 2014 extends longitudinally through the knot slider 2030 of the housing 2010' and is in communication with a base recess 2025 within the base 2020.
- the base 2020 is detachably coupled to the housing 2010'. More specifically, the base 2020 is held within the housing sleeve 2011'.
- the channel 2014 may be formed continuously with the base recess 2025 within the cartridge base 2020.
- the channel 1014 and the base recess 1025 both function as a restraint 25 ( Fig.8E(i) ), to constrain or restrict the lateral and transverse movement of the suturing instrument 900 within the cartridge 2000 while allowing the suturing instrument 900 to be advanced linearly or axially therein in sliding engagement to maintain the position of the suturing instrument 900 along the longitudinal axis as it is advanced.
- the restraint 25 constraints or limits the movement of the suturing instrument 900 in the transverse and lateral directions as well along a longitudinal path defined thereby.
- the restraint 25 facilitates alignment of the suturing instrument 900 with a portion of the suture 500 that is held within a seat 1022 defined by the base 20207 More specifically, the channel 1014 and the recess 1025 allow the suturing instrument 900 to be advanced therein in sliding engagement therein and additionally function to restrain the suturing instrument 900 in a linear path as it is advanced along the cartridge 2000 to allow the seat 1022 to be aligned with the suture receiving passage 932 of the suture passing member 930.
- the recess 2025 within the base is formed from two grooves, an instrument receiving groove 2025a defining an instrument receiving recess as shown in Fig. 8E(i) and Fig. 8E(ii) and a suture receiving groove 1025b defining a suture receiving recess, as shown in Fig. 8F(i) and Fig. 8F(ii) .
- the instrument and suture receiving grooves 2025a and 2025b respectively are formed within the opposing halves 2020a and 2020b of the base 2020 (as illustrated in Figs. 8E(i)-Fig.8F(ii) ).
- the instrument receiving groove 2025a defines an instrument receiving recess by providing a track which functions as a restraint 25 to allow the suturing instrument 900 to be advanced therein
- suture groove 2025b Figs.8F(i)
- suture groove 2025b provides a track to guide the portion of the suture held within the seat into the suture passing member 930 of the suturing instrument 900 by maintaining/routing the suture 500 therein such that it is adjacent and in line with the shaft or proximal portion 910 of the suturing instrument 900 that is receivable within the instrument receiving groove 2025a as further illustrated in Figs. 8F(ii) and 8G .
- the suture receiving groove 2025b allows the suture to be routed such that when the suturing instrument is received within the instrument receiving recess 2025b, the suture 500 is held adjacent the groove 928 within the shaft or the instrument proximal portion 910 as well groove 938 within suture passing member 930 such as needle 930' (shown in Fig. IE). Furthermore, the groove 2025b provides room for routing the suture without excess tension being placed in the suture by providing a wider opening into a rocker recess 2027 as shown by Fig. 8F(ii) .
- the groove 2025b accommodates the suture as it enters a rocker recess 2027 in both a final position 1041B as well as an initial position 1041A of a rocker 1041 (Discussed further herein below).
- the suture receiving groove 2025b enables the suture 500 to be maintained out of the way of the advancing suturing instrument 900 during use of the cartridge 2000.
- recess groove 2025b is in line with grooves 928, 938 within the suturing instrument 900 to further facilitate transfer of suture from a seat 2022 for example within the rocker 1041 within the base 2020 into the needle 930'.
- both the instrument receiving groove and the suture receiving groove exit into the rocker recess 2027.
- the cartridge 2000 additionally provides a pre-tied knot and a means to load the pre-tied knot onto the suturing instrument 900.
- the cartridge defines a chamber 2010 and a means to mount or retain a pre-tied knot about the chamber 2010.
- a knot slider 2030 is provided with reference to Fig. 8C that enables a pre-tied knot to be mounted thereon so that it is held about and surrounds or circumscribes the chamber 2010. This enables the suturing instrument 900 to be received through a channel 2014 within the chamber 2010 such that is passes through the pre-tied knot to allow the pre-tied knot to be mounted thereon.
- the knot slider forms a mount 2012" for holding the pre-tied knot 502 about the chamber 2010, as shown in Figs. 8B and 8C .
- the pre-tied knot 502 may be of the type as previously illustrated herein in Fig. 1A .
- the knot slider 2030 forms an instrument mounted component of the cartridge 2000.
- the knot slider 2030 is held within a knot slider recess 2018 ( Fig. 8B and Fig. 8C ) within the outer sleeve 2011' and is detachably coupled thereto via the base 2020.
- the knot slider 2030 is detachably coupled to the base 2020 via a knot slider release interlock 2033 that for example comprises a snap fit arrangement as shown in Fig. 8H(i) As additionally illustrated in Figs.
- the base comprises snap arms 2042 that are receivable within and engageable with grooves formed within the knot slider 2030 that may be referred to as snap grooves 2032 to couple knot slider 2030 therein, forming the knot slider release interlock 2033.
- the base 2020 additionally comprises a knot slider s 2040 therein that is configured for receiving a portion of the knot slider 2030 therein.
- the knot slider 2030 is detachable from the base to enable loading of the knot slider 2030 and thus the pre-tied knot 502 onto the suturing instrument 900 upon disengagement of the knot slider release interlock 2033.
- the knot slider 2030 is detachable from the base 2020 upon relative movement of base 2020 with respect to the housing 2010'.
- the knot slider 2030 is moveable distally along the knot slider recess 2018 within the housing sleeve 2011' upon distal movement of the base 2020 within the housing sleeve 2011'.
- knot slider recess 2018 functions as a stop to prevent further distal movement of the knot slider 2030 to disengage snap arms 2042 of the base 2020 from the snap grooves of the knot slider 2030, and as such disengages the knot slider release interlock 2033.
- the cartridge 2000 defines a moveable seat 1022 as previously described herein above with reference to Fig. 3C , the seat 1022 is automatically moveable upon insertion of the suturing instrument 900 within the cartridge 2000.
- the cartridge 2000 comprises a magazine 1021 comprising a rocker 1041 that is rotatable about a pivot, and the base 2020 defines a rocker recess 2027 for enabling pivotal movement of the rocker 1041 therein.
- the rocker 1041 is moveable about the pivot 1042 from its initial position 1041A (as shown in Fig.9A(i) , (ii) ) to its second position 1041B (as shown in Fig.9B(i),(ii) ) in order to align the seat 1022 and the suture end 504 held therein with the path of an advancing suturing instrument 900 that is inserted within the cartridge 2000.
- the rocker 1041 is moveable within the rocker recess 2027.
- the rocker 1041 is moveable from its first position 1041A into a rocker cavity 2027' its second position 1041B, as shown in Fig.
- the rocker cavity 2027' is defined as a portion of the rocker recess 2027 that corresponds to the tissue receiving gap 942 of the suturing instrument 900 once suturing instrument 900 is positioned within the base 2020 of the cartridge 2000 upon loading of the cartridge 2000 onto the suturing instrument.
- the rocker 1041 is held in its initial position 1041A within the rocker recess 2027 through frictional engagement.
- the rocker 1041 may be kept in its initial position 1041A by an engagement feature such as a raised tab or detent 2029 as shown in Figs. 8C and 8F(i) , that frictionally engages the rocker 1041.
- the tab or detent 2029 is formed within the base 2020 and may extend or jut into the rocker recess 2027.
- the tab 2029 is engageable with a portion of the rocker 1041(for example a nose portion 1081) of the rocker 1041 as shown in Fig. 8F(ii) , to maintain the rocker in its initial position 1041A during shipment and prior to use.
- the cartridge 2000 may comprise additional features that assist in aligning the seat 1022 with a portion of the suturing instrument 900 as the suture passing member 930 held within the shaft or instrument proximal portion or shaft 910.
- the rocker 1041 additionally defines an instrument receiving or locking recess defined by a groove 1044 that is designed for receiving the suturing instrument 900 as it is advanced distally.
- the groove 1044 functions as a restrain to position the suturing instrument 900 in a desired position relative to the seat 1022 to assist in aligning the seat 1022 with a suture passing instrument 900. As shown and discussed previously with reference to Figs.
- the groove 1044 comprises a groove proximal portion 1046 for receiving the instrument proximal portion or shaft 910 of the suturing instrument 900, and additionally comprises a groove distal portion 1048 for receiving the instrument distal portion or tip 920.
- the rocker 1041 of Example 4 additionally comprises a median 1047 ( Fig.9A(i) that is defined by the groove 1044 that functions as an alignment feature by holding and aligning the seat 1022 with the suture passing member such as needle 930' of the suturing instrument 900.
- the groove 1044 defines an additional alignment feature in the form of an interior bevel face 1043 ( Fig.9A(i) ) within the distal groove portion 1048 to enables the distal portion 920 of the suturing instrument to pivot the rocker 1041 from its initial position 1041A into its aligned position or second position 1041B to enable alignment of the seat 1022 and the suture held therein with the suture passing member 930 of the suturing instrument.
- the rocker 1041 additionally defines another alignment feature in the form of a rocker slot 1049 (as shown earlier in Figs. 3J , 3L ) within the groove 1044 to assist in alignment and transfer of the suture end 504 into the suture passing member 930.
- the slot 1049 comprises a slit or channel 1049a (also shown in Fig.9A(i) ) that exit into a side slot 1049b within the rocker 1041, to aid in routing the suture 500 within the suture receiving groove 2025b ( Fig. 8F(ii) ) of the base 2020 to assist in aligning the suture with the suture receiving slot 928 in the shaft.
- the rocker 1041 defines a rocker slot 1049 for routing the suture 500 there-through to enable the suture 500 to be kept out of the way of a path of the suturing instrument 900 upon advancement of the suturing instrument 900 therein. For example when a portion of the instrument proximal portion 910 is received within the groove proximal portion 1046 of the rocker groove 1044.
- the seat 1022 is defined by a projection 1030 that is housed within the magazine 1021, specifically within the rocker 1041. As shown in Fig. 3M and 4D , the projection 1030 extends into the instrument receiving recess defined by the groove 1044 (specifically, the groove proximal portion 1046). More specifically, the median functions to hold the projection 1030 within the groove proximal potion 1046 of the rocker. In some examples the projection 1030 defining the seat 1022 may be formed in one piece as part of the rocker.
- the projection 1030 additionally defines a bevel face 1034 for engaging with a bevel face 934 of the needle 930' for docking the needle 930' to align the seat 1022 with the needle 930' with to permit transfer of the suture end 504 from the seat 1022 into a suture receiving passage 932 of the needle 930'.
- the projection 1030 is receivable into the instrument proximal portion or shaft 910 to facilitate alignment of the seat 1022 with the needle 930'.
- the rocker may define a seat recess or seat channel and an alignment recess 1030' that is located adjacent the seat 1022.
- the alignment recess 1030' is configured for receiving the suture passing member 930 such as needle 930' in its needle out configuration to align the seat with the suture passing member.
- the rocker 1041 comprises additional alignment features such as interference features in the form of raised bumps 1045a on the exterior of the projection 1030 that are configured to frictionally engage the interior of the instrument proximal portion or shaft 910 with the needle 930' as the projection 1030 is received within the shaft 910.
- the rocker 1041 additionally comprises additional raised bumps 1045b along the interior of the proximal groove portion 1046 for frictionally engaging the exterior of the instrument proximal portion or shaft 910 once it is received within the proximal groove portion 1046.
- the raised bumps 1045a, 1045b help to align the seat 1022 with the needle 930'.
- projection 1030 defines a suture slot 1038 therein allowing the suture 500 to exit therefrom to enable alignment of the suture end 504 with the suture receiving passage 932 within the needle 930'.
- the rocker 1041 additionally comprises interference tabs 1048x ((as shown in Fig.9A (iii) , and Fig.9B (i) as discussed earlier with respect to Fig. 3M ) for engagement with the suturing instrument 900 which allow the rocker 1041 to over-rotate to ensure alignment of the rocker 1041 with the instrument proximal portion or shaft 910 of the suturing instrument 900 to allow advancement of the rocker 1041 along the shaft 910.
- the interference tabs 1048x may allow the rocker 1041 to rotate sufficiently to enable the seat 1022 to be positioned adjacent the suturing instrument 900 by ensuring that the shaft 910 is received within the rocker groove proximal portion 1046.
- the interference tabs allow the rocker 1041 to rotate sufficiently to enable the projection 1030 to be received within the instrument shaft 910.
- the interference tabs allow the rocker 1041 to rotate sufficiently such that the alignment recess and the seat 1022 adjacent to it are both aligned with the needle 930'.
- some examples provide a housing sleeve 2011' that is detachably coupled to the base 2020 and remains coupled to the base 2020 to operate as a single unit upon loading of the cartridge 2000 onto the suturing instrument 900.
- the housing sleeve 2011' remains coupled to the base 2020 until the seat 1022 is aligned with the suture passing member 930 of the suturing instrument 900.
- the cartridge sleeve 2011' is detachable from the base 2020 thereafter to transfer suture from base 2020 into the suturing instrument 900.
- the cartridge housing 2010' defines a suture transferring component 2011.
- the cartridge base 2020 is detachably coupled to the suture transferring component 2011 of the housing 2010' via an interlock 2050.
- the interlock 2050 secures the base 2020 to the housing 2010' in its initial position 2050A may then be disengaged to move into its second position 2050B [shown later in Figs. 9D[i],[ii] ) to allow the housing sleeve 2011' that comprises the suture transferring component 2011 to translate independently relative to the base 2020 to transfer the suture end 504 from the seat 1022 into the suture passing member 930 of the suturing instrument 900.
- Figs. 9D[i],[ii] the housing sleeve 2011' that comprises the suture transferring component 2011 to translate independently relative to the base 2020 to transfer the suture end 504 from the seat 1022 into the suture passing member 930 of the suturing instrument 900.
- FIGB[i],[ii] and 9C[i],[ii] illustrate the interlock 2050 in its initial locked position 2050A, with an interlock arm 2056 being axially aligned with and being position distal to the base 2020 preventing longitudinal movement of the base 2020 with respect to the housing 2010'.
- the interlock 2050 is moveable to its unlocked position 2050B (as shown in Figs. 9D[i],[ii] ) to disengage the transferring component from the base to enable relative movement there-between upon alignment of the seat with a suture passing member of the suturing instrument.
- the function of the interlock 2050 is described further herein below with respect to Figs. 9C[i]-9D[ii] .
- the interlock 2050 comprises a manual interlock that is moveable into the unlocked position 2050B to manually disengage the suture transferring component 2011 from the base 2020 upon alignment of the seat 1022 with the suture passing member 930.
- the interlock 2050 comprises an automatic interlock ( Fig. 9A[i] ) that functions to automatically disengage the suture transferring component 2011 from the base 2020 upon alignment of the seat 1022 with the suture passing member 930.
- the operation of the interlock 2050 is partially automatic wherein the interlock 2050 comprises an interlock tab 2054 (as shown in Fig.9A[i] ), that is automatically disengaged upon alignment of the seat 1022 with the suture passing member 930 to enable the interlock 2050 to be moved manually into its unlocked position 2050B ( Fig.9E[i] ). This enables the base 2020 to be disengaged from the suture transferring component 2011.
- the rocker 1041 comprises a rocker bar 2055 that is moveable upon alignment of the seat 1022 to disengage the interlock tab 2054. This is discussed further herein below with reference to Figs. 9A[i]- 9B[ii] .
- the suture transferring component 2011 comprises a push rod 2058, wherein the suture transferring component 2011 is moveable with respect to the base 2020 to enable movement of the base 2020 therein to engage a push rod 2058 to push the suture end 504 held within the seat 1022 to transfer it to the surgical suturing instrument 900.
- the push rod 2058 comprises a push rod hub 2057 that is configured to translate within push rod cavity 2057'.
- the suture transferring component 2011 comprises a sleeve push hub 2012 to push the push rod hub 2057 once in engagement therewith.
- the push sleeve hub 2012 is moveable within a sleeve cavity 2012' and is biased towards the base 2020.
- the push sleeve hub 2012 is biased via a spring mechanism.
- the spring mechanism comprises two springs 2013.
- the push sleeve hub 2012 is configured to push the push rod hub 2057 upon translation of the suture transferring component 2011 with respect to the base 2020.
- the suture transferring component 2011 comprises a hub, such as sleeve push hub 2012 that is biased towards the base 2020 to push the push rod 2058 upon engagement with the push rod 2058 upon translation of the base 2020 within the housing sleeve 2011'.
- the sleeve push hub 2012 is biased via a spring mechanism.
- the push rod 2058 comprises a longitudinally extending wire 2053' coupled to the push rod hub 2057 that is translatable within a wire channel 2053 in communication with the seat 1022 for receiving the wire 2053' therein to push the suture end 504 held within the seat 1022 into a suture receiving passage 932 of the suturing instrument 900.
- the cartridge 2000 comprises a suture transferring component 2011 defines a push mechanism as described herein above.
- the push mechanism is defined as the mechanism of the cartridge that enables a pushing force to be applied to the suture portion such as the suture end to transfer from the seat into the suturing instrument.
- the push mechanism comprises a push rod 2058 as described above.
- the cartridge 200 is configured to align and transfer the suture end 504 upon a single linear movement of the cartridge 2000 with respect to the suturing instrument 900.
- surgical suturing instrument 900 comprises a suture passing member 930 defining a suture receiving passage 932 wherein the suture transferring component 2011 that is operable to transfer an end of the suture 500 from the seat 1022 within the base 2020 into the suture receiving passage 932 of the suturing instrument 900.
- the knot slider 2030 is coupled to the suturing instrument 900.
- the knot slider 2030 configured to be slidably engaged with a portion of the surgical suturing instrument to allow the knot slider 2030 to be mounted thereon.
- the knot slider 2030 is engageable in sliding contact with a portion of the suturing instrument 900 for positioning the knot slider 2030 along the suturing instrument to facilitate deployment of the pre-tied knot 502 from the knot slider 2030.
- the knot slider 2030 is engageable in sliding contact with the suturing instrument via an arm 2034 that is receivable within an opening/window or groove 965 [ Fig. 1C ] along the side of the instrument proximal portion 910.
- the knot slider arm 2034 enables positioning of the suturing instrument along the tissue receiving gap 942 to facilitate deployment of the pre-tied knot from the suturing instrument 900 during use. Furthermore in some examples, the knot slider arm 2034 is housed within a slider groove 2036 and comprises an inner position 2034A where it is housed within the slider groove 2036 [ Fig. 8D , Fig. 11A ]. The knot slider arm 2034 additionally and an outer position 2034B where it extends proximally (at least partially) from the slider groove 2036 [ Fig. 11B ] to allow the knot slider 2030 to be positioned over the tissue receiving gap 942.
- the suture is contained within tubing mounted on the inside the knot slider 2030.
- the cartridge 2000 stores the suture limbs within the knot slider 2030 for example inside a polytetrafluoroethylene (PTFE) tube that may be coiled and mounted about an internal post 2037 an internal knot slider 2030x that defining a passage 2037' about it once it is press fit inside the external knot slider 2030y as shown in Fig. 11.D
- the PTFE tube may allow the suture to be released with a constant and small force. In other examples, the force of the suture payout may not be constant.
- a silicone O-ring provides a dampening effect on the release of the suture to achieve a smoother, more constant force of release and to retain tautness in the Suture throughout the procedure.
- the movement of the suturing instrument 900 may be a relative movement with respect to the cartridge 2000, with reference now to example 4.
- the user may move the cartridge 2000 axially over the suturing instrument 900 in a proximal direction while the suturing instrument is held by the user in order to create a relative advancement of the suturing instrument 900 with respect to the cartridge 2000 in order to load the suture onto the suturing instrument 900.
- This may be referred to as loading of suture using pumping action.
- the mechanism of loading of the suture may remain as described above but the movement may be created either by the proximal movement of the cartridge over the suturing instrument or the distal movement of the suturing instrument within the cartridge.
- the cartridge is configured to align and transfer the suture upon a single linear motion of the cartridge with respect to the suturing instrument.
- an interlock 2050 may be automatically disengaged upon alignment of the suture end within the seat with the suture passing member to enable automatic transfer of the suture end 504 into the suture passing member (due to advancement of the base and activation/engagement of the push rod) as the housing 1010' is continued to be pulled proximally.
- the cartridge enables a pre-tied knot be mounted onto the suturing instrument during the same linear movement of the cartridge.
- the mechanism provided may be similar to the mechanism described herein above with respect to the knot slider 2030.
- examples may comprise a cartridge that is operable to transfer suture portion such as the suture end 504 from the seat 1022 into the suture passing member 930, which would allow the suturing instrument to be able to pass the suture in order to suture therewith, as well as enable a pre-tied knot to be mounted onto the suturing instrument.
- the cartridge is loaded onto the suturing instrument 900 with a single linear movement.
- a single pumping action is used involving a single linear relative movement of the cartridge onto the suturing instrument (to transfer the suture end mount the pre-tied knot) and linear movement the cartridge 2000 [in a direction opposite to the loading direction] thereafter leaving the knot slider 2030 coupled to the suturing instrument 900 for example to mount a pre-tied knot held therein onto the suturing instrument. As such the remainder of the cartridge 2000 other than the knot slider 2030 is removed.
- FIG. 12A-12F A further example of a side load alignment mechanism 1100" is shown in Figs. 12A-12F .
- the 1121 magazine defines a button 1123 shown in its initial position 1121A [ Fig. 12A , 12E ] comprising a side loading sliding seat 1122' [ Fig. 12B ].
- the base 1120 defines a magazine recess 1127 defining a magazine cavity 1127' and the magazine 1121 is moveable within the magazine recess. Initially, the instrument is advanceable into the base recess 1025 that functions as a restraint to maintain the position of the suturing instrument 900 as it is advanced distally within the base 1120. Upon loading of the cartridge onto the suturing instrument the magazine [ Fig.
- the cavity 1127' corresponds to the tissue receiving gap 942.
- the tissue receiving gap 942 of the suturing instrument 900 is positioned within the magazine cavity 1127' [As shown in Fig. 12C ].
- the magazine 1121 is then moveable sideways into the magazine cavity 1127' to align the seat 1122' with respect to the suturing instrument 900.
- Fig. 12D illustrates a side view of the base 1120 with the button in its depressed or second position 1121A
- Fig. 12E illustrates an end view of the same.
- a mechanism for providing both alignment and insertion that may facilitate ease of use by reducing: the number of user steps required, requirements for user dexterity and concentration and in some examples additionally facilitates use by providing only one possible order of performing the user steps.
- two events or functions take place: (1) alignment of the suture portion held within the cartridge with a suture receiving feature within the surgical suturing instrument or the suture passer and (2) insertion of the suture portion into the suture receiving feature within the suturing instrument or suture passer.
- Example 5 includes various alternatives to features described above and/or additional features not previously mentioned, including but not limited to: movement of the magazine, for example the rocker, alignment of the seat and/or rocker, reversibility-prevention features when suture has not been loaded, coupling of the rocker to the push-rod hub, indicator for indicating loading or transfer of suture onto the suturing instrument, interlock to prevent insertion of the suturing instrument in an incompatible orientation and features related to the knot slider.
- movement of the magazine for example the rocker
- alignment of the seat and/or rocker reversibility-prevention features when suture has not been loaded
- coupling of the rocker to the push-rod hub indicator for indicating loading or transfer of suture onto the suturing instrument
- interlock to prevent insertion of the suturing instrument in an incompatible orientation and features related to the knot slider.
- a cartridge 4000 is shown that is usable for loading a portion of a suture onto a suturing instrument, such as suturing instrument 900 described previously herein above.
- the cartridge 4000 comprises a housing 4010' that comprises a housing sleeve 4011' and a knot deployment mechanism such as a knot slider 4030, with the housing 4010' defining a chamber 4010 for axially receiving the surgical suturing instrument 900 therein and a means for securing or mounting a pre-tied knot 502 ( Figure 13B ) about the chamber 4010.
- the knot deployment mechanism or knot slider 4030 is detachably coupled to the cartridge housing sleeve 4011' by a coupling mechanism comprising a knot slider release mechanism 4060 as shown.
- the cartridge 4000 as shown in Fig. 13B defines a path for insertion of the suturing instrument 900 within the cartridge 4000 and to facilitate removal of the suturing instrument 900 therefrom.
- the path comprises a linear path and may be partially defined by the chamber 4010.
- the cartridge 4000 additionally comprises a magazine 4021 which defines a seat 4022 for releasably holding a portion of a suture.
- the magazine 4021 comprises a rocker 4041 as shown in Fig. 13B .
- Rocker 4041 is similar to the rocker 1041 illustrated in Example 4; significantly, however, unlike examples described previously hereinabove, the embodiment of the cartridge shown in Figure 33B lacks a base and the rocker 4041 is held directly within the cartridge housing 4010' and is directly coupled to the housing 4010'.
- cartridge 4000 includes a translation mechanism 4085 for moving rocker 4041 and seat 4022 in a controlled and constrained manner.
- a translation mechanism is a feature or component that allows for movement, including but not limited to linear or rotational movement. The translation mechanism 4085 allows for the seat 4022 to move out of the path of the suturing instrument 900 for withdrawal of the suturing instrument 900 from the cartridge 4000.
- the translation mechanism 4085 enables movement of the rocker 4041 to move the seat 4022 into alignment with the suturing instrument 900 upon advancement of the suturing instrument 900 within the cartridge 4000.
- the suturing instrument 900 may be of the type described previously herein above with reference to Figs. 1C-1E , where the instrument comprises a proximal portion 910, and a distal portion 920 coupled thereto with a tissue receiving gap 942 defined there-between for receiving a tissue to be sutured.
- the translation mechanism 4085 enables movement of seat 4022 into and out of the tissue receiving gap 942 to allow for alignment of the seat with the suturing instrument and withdrawal of the suturing instrument, respectively.
- the translation mechanism 4085 comprises a rotational mechanism.
- the translation mechanism may comprise a spring biased mechanism operable for linear movement.
- the rotational translation mechanism includes an arcuate track 4080 defined by the cartridge housing 4010', and one or more laterally extending pins 4082 defined by the rocker 4041 that are receivable within the track 4080.
- the housing sleeve 4011' of the cartridge housing 4010' includes a groove or track 4080 formed by ribs 4081, that defines a curved path, i.e.
- the track 4080 When assembled, the track 4080 receives rocker pins 4046' and functions to allow the rocker 4041 to rotate in a pivoting manner while remaining constrained by the track 4080 within the housing 4010'.
- the rotational translation mechanism 4045 allows the rocker 4041 to move between a first position 4041A, as shown in Fig. 13B and Fig. 18F , for positioning the seat 4022 out of the path of the suturing instrument, and a second position 4041B, as shown in Fig. 18C (i) and Fig. 18D(ii) , for positioning the seat 4022 in alignment with a portion of the suturing instrument 900, such as the instrument proximal portion 910.
- the rocker 4041 is moveable from its first position 4041A shown in Fig. 18Ai ), 18Aii) where the seat 4022 positioned out of the path of the suturing instrument 900, into its second position 4041B where the seat is in alignment with the suturing instrument 900 and positioned within the tissue receiving gap 942 as shown in Figs. 18Ci ), 18Cii).
- Figs. 18Bi) and 18Bii ) indicate the position of the rocker 4041 in its intermediate position as it moves from its first position 4041A towards its second position 4041B.
- 18Aii ) and 18Bii ) and 18Cii) illustrate the position of the rocker 4041 and the suturing instrument 900 in isolation from the remainder of the cartridge 4000 in order to provide additional clarity.
- the rocker 4041 further allows the seat 4022 to be moved out of the path of the suturing instrument 900 after the suture portion has been transferred to the suturing instrument 900. More specifically, the rocker 4041 is pivotable from its second position 4041B to its first position 4041A to allow the seat 4022 to be moved out of the tissue receiving gap 942 of the suturing instrument 900 to allow retraction of the suturing instrument 900 as shown in Figs. 18E and 18F .
- rocker 4041 includes a resilient member or flex-arm 4031 that is operable to engage with the cartridge housing 4010', for example with a locking rib 4031' within the housing sleeve 4011'.
- Resilient member 4031 in cooperation with locking rib 4031', thus functions to maintain rocker 4041 in a desired initial or first position 4041A which facilitates unimpeded advancement of the suturing instrument 900. Movement of the rocker 4041 is otherwise similar to that of rocker 1041 described herein with respect to Figs. 9A [i]-9B [ii] .
- Fig. 13G which illustrates a partial cut-away view of the rocker 4041 along a longitudinal axis of the rocker, with a left side portion of the rocker 4041 being visible.
- the rocker 4041 defines a first or distal bevel face 4043 facing towards the interior of a rocker groove 4044, and more specifically defines a distal wall of the groove distal portion 4048, similar to bevel face 1043 discussed previously hereinabove with reference to Fig.9A (i) .
- the distal portion of suturing instrument 900 is configured to interact with the first bevel face 4043 upon advancement of the suturing instrument 900 within the cartridge 4000 as shown in Figs 18Ai ), 18Aii) which illustrate the rocker 4041 in a partial breakaway view with the rocker 4041 being shown in .
- the rocker 4041 defines a second or proximal bevel face similar to bevel face 1043' shown in the embodiment illustrated in Fig. 10B , which faces towards the interior of the rocker groove 4044, and more specifically defines a proximal wall of the groove distal portion 4048.
- the second bevel face is formed in a right side portion of the rocker 4041 [not visible in Fig. 13G ].
- the distal portion 920 of suturing instrument 900 is configured to interact with the second bevel face upon retraction of the suturing instrument 900 from the cartridge 4000.
- the cartridge 4000 comprises several alignment features to facilitate alignment of the seat 4022 with a portion of the suturing instrument 900 to permit transfer of a suture portion held within the seat 4022 onto the suturing instrument 900.
- the alignment feature comprises an instrument guiding feature to guide the suturing instrument within the cartridge 4000.
- the instrument guiding feature is defined by the magazine 4021 such as the rocker 4041.
- the instrument guiding feature comprises one or resilient members 4035 that extend from the magazine 4021.
- the one or more resilient members 4035 comprise one or more horizontally aligning side arms 4037 for aligning the suturing instrument horizontally with the seat 4022.
- the side arms 4037 guide the shaft or instrument proximal portion 910 of the suturing instrument 900 up to seat 4022 such that the seat cavity or recess 4022' defined by the seat 4022, is horizontally or laterally aligned with the instrument proximal portion 910.
- the horizontally aligning side arms 4037 extend from the rocker 4041 such that they straddle the suturing instrument 900 along its sides upon insertion of the suturing instrument 900 within the cartridge 4000. Additionally, in some examples, as shown for example in Figs.
- the rocker 4041 may comprise the one or more resilient members 4035 that comprise one or more vertically aligning side arms 4039 for aligning the suturing instrument vertically with the seat.
- the one or more side arms 4039 comprise a downwardly extending flex arm for engaging an upper surface of the suturing instrument 900.
- the horizontally aligning side arms 4037 and vertically aligning side arms 4039 enable alignment of the suture passing member such as needle 930' and the suture receiving recess 932 defined thereby, with the seat cavity or recess 4022' which is moveable into the tissue receiving gap 942 of the suturing instrument 900 as shown in Fig. 13B .
- the one or more horizontally aligning side arms 4037 may comprise an alternate configuration.
- the side arms 4037A are shown that extend from an upper surface or top portion 4041t of the rocker 4041.
- the side arm 4037A defines a slot s for routing and guiding suture to the side of the rocker 4041.
- side arms 4037B are provided that extend distally from a front or proximal face 4041p of the rocker 4041, as shown in Fig. 13I .
- the one or more side arms 4037C may extend proximally from an intermediate portion 4041i of the rocker 4041 that is positioned distal to the proximal face 4041p of the rocker 4041, as shown in Fig. 13J . Furthermore, as shown in Figs. 13H to 13J , in some examples the one or more side arms 4037A, 4037B and 4037C extend into a space or gap 4041g.
- the instrument guiding feature is defined by the cartridge housing 4010'.
- the instrument guiding feature comprises guiding ribs 4036 within the housing sleeve 4011' of cartridge housing 4010'.
- the suturing instrument 900 is guided and constrained by ribs within the cartridge housing 4010'.
- the guiding ribs 4036 may be provided such that they accommodate suturing instruments 900 of varying surfaces flatness and may additionally help prevent binding of the suture.
- the guiding ribs 4036 function to guide the suturing instrument 900 into alignment with the rocker 4041.
- the cartridge 4000 additionally comprises a suture guiding or routing feature to allow the suture to be routed within the cartridge 4000.
- the suture guiding feature is also defined by the guiding ribs 4036.
- the guiding ribs 4036 provide clearance for the suture to run from (in some examples, a pre-tied knot mounted on) the knot slider 4030 to the rocker 4041.
- additional instrument guiding features are defined by the magazine 4021/rocker 4041.
- the rocker 4041 defines a locking recess 4044 for receiving a portion of the suturing instrument 900 in press-fit engagement for aligning the seat with the portion of the suturing instrument.
- the locking recess 4044 is defined by the edge 4044'.
- the magazine 4021 comprises a projection 4030' defining the seat 4022, as shown in Fig. 13G .
- the projection 4030' comprises one or more reference features 4045a for engaging with an interior of a portion of the suturing instrument 900 for aligning the seat 4022 with the portion of the suturing instrument 900.
- the rocker 4041 additionally defines a channel 4053 in communication with the seat 4022 for allowing movement of a push rod 4053' there-through for advancing a suture end from the seat 4022 into the suturing instrument 900.
- the rocker 4041 comprises lateral halves 4041h1, 4041h2 that are configured to co-operatively engage with one another to form the rocker 4041.
- the lateral halves 4041h1, 4041h2 engage one another via a snap fit or press fit mechanism 4050.
- the snap fit mechanism 4050 comprises a tab 4052 that is receivable within an opening 4051 to be engaged there-with.
- the seat 4022 comprises a seat cavity or seat recess 4022' that is defined by the rocker 4041, where the seat cavity or seat recess 4022' is in communication with the wire channel 4053 and extends from the wire channel 4053.
- the seat 4022 is defined by a tubular member 4022a, as shown in Fig. 14B , that defines an aperture 4022a' that is in communication with the wire channel 4053.
- tubular member 4022a comprises a sleeve 4022b that can be inserted within the rocker 4041 to form the seat 4022.
- the sleeve 4022b defines an opening 4023 in order to provide strain relief to allow it to bend without constricting the inner tube diameter and thus it provides flexibility within the tubular member for ease of insertion and assembly of the seat 4022 within the rocker 4041.
- the rocker 4041 comprises a rocker body 4041b and an insert 4041n defining the seat 4022.
- the insert 4041n defines a wall or median 4047 that allows a portion of the suturing instrument to rest there-against to facilitate alignment, with the instrument distal portion 920 being received in a distal groove portion 4048, the proximal portion 910 being received in a proximal groove portion 4046 and the seat 4022 being positioned within the tissue receiving gap 942, as shown in Fig. 18C(i) .
- Fig. 18C(i) In alternate examples, as shown for example in Fig.
- the insert 4041n defines a rocker recess 4024 for receiving a portion 4024' of the rocker body 4041b therein for securing the insert 4041n within the rocker body 4041b.
- the seat insert 4041n comprises a single unit that is receivable within the rocker 4041.
- the insert 4041n further comprises a hub 4025 that is coupled to a tubular member defining the seat 4022 using a coupling mechanism.
- the tubular member may comprise a tubular member 4022a similar to the embodiment illustrated in Fig. 14B . In other examples, as shown in Fig.
- the tubular member may comprise a sleeve 4022b of the type shown in Fig. 14C that is coupled to the hub 4025, with the sleeve 4022b comprising a cut-out or notch/opening 4023 to provide feature for the glue to adhere to, whereas the opening within sleeve 4022b that opens into the channel 4053 provides clearance for a push rod to enter the sleeve 4022b.
- the seat 4022 and the hub 4025 each comprise a polymer.
- the polymer comprises Acrylonitrile butadiene styrene (ABS).
- the coupling mechanism for coupling the hub and the tubular member comprises a polymer weld.
- the seat 4022 and the hub 4025 may each comprise a metal such as stainless steel, wherein the coupling mechanism may comprise a metal weld such as a laser weld for example as illustrated in Fig. 14F .
- the coupling mechanism may comprise an adhesive 4028 such as glue, as shown in Figs. 14E and 14G .
- the wire channel 4053 (not labeled in all figures) in conjunction with the seat cavity 4022' comprises a substantially s-shaped configuration.
- the cartridge 4000 additionally comprises an instrument retention mechanism 4070 that is configured to permit advancement of a suturing instrument 900 into the cartridge 4000 and to prevent premature retraction or withdrawal there-from until the suture portion is loaded onto the suturing instrument 900.
- the instrument retention mechanism 4070 comprises a lock such as a biased locking element 4072' that is moveable away from or out of the path of the advancing suturing instrument 900 to allow substantially unimpeded advancement of the suturing instrument 900 within the cartridge 4000.
- the biased locking element 4072' comprises a resilient member that flexes, bends or otherwise moves out of the way of the advancing suturing instrument 900 to allow the distal portion 920 of the suturing instrument 900 to advance past the biased locking element 4072'.
- the biased locking element 4072' comprises a resilient member that flexes, bends or otherwise moves out of the way of the advancing suturing instrument 900 to allow the distal portion 920 of the suturing instrument 900 to advance past the biased locking element 4072'.
- the biased locking element 4072' is configured to engage the proximal portion 910 of the suturing instrument 900, specifically a window or groove 955 of the suturing instrument 900 to thereby substantially prevent, obstruct or limit retraction of the suturing instrument 900 prior to loading of suture onto the suturing instrument 900.
- a lock release mechanism is provided in order to disengage the lock.
- a lock release mechanism is provided that may be manually operable to disengage the biased locking element 4072' from the window or groove 955.
- a lock release mechanism is provided that is configured to automatically disengage the lock upon transfer or loading of the suture portion onto the suturing instrument 900.
- the lock release mechanism comprises a spring biased component such as a release arm 4076 that is coupled to a biasing mechanism 4090.
- the biasing mechanism 4090 is operable to move the release arm 4076 upon transfer of the suture portion to disengage locking element 4072' from the suturing instrument 900.
- a biased locking element comprises a rotational locking mechanism 4074, wherein the rotational locking mechanism 4074 comprises a rotatable swing arm 4075, terminating in a tab 4075t.
- the rotatable swing arm 4075 is biased via a torsion spring.
- the swing arm 4075 is moveable out of the way or path (as illustrated in the dashed outline provided in Fig. 16B ) of the suturing instrument 900 in order to allow advancement of the suturing instrument 900 within the cartridge.
- tab 4075t defines a beveled surface.
- the swing arm 4075 In use, once the distal portion and the tissue receiving gap of the suturing instrument 900 are positioned distal of the tab 4075t, the swing arm 4075 is moved into the path of the suturing instrument 900 such that tab 4075t engages with the window or groove 955.
- a release arm 4076 is moveable adjacent the swing arm 4075 to prevent rotation thereof for maintaining the tab within the groove or window 955.
- the swing arm 4075 functions to lock the suturing instrument 900 within the cartridge to prevent retraction or withdrawal of the suturing instrument 900 prior to loading of the suture onto the suturing instrument 900. As shown in Fig.
- the release arm 4076 is then translatable or moveable away from the swing arm 4075 to allow rotation thereof to permit disengagement of the tab from the suturing instrument 900 to permit retraction and removal of the suturing instrument 900 from the cartridge.
- the lock may comprise a resilient member biased for engaging with the suturing instrument 900 and the release arm may be operable to allow disengagement of the resilient member from the suturing instrument.
- the lock comprises a resilient member 4079 such as a resilient arm for engaging with the suturing instrument 900 for example with the window or groove 955 of the suturing instrument 900.
- a lock release mechanism 4077 is provided for disengaging the member 4079 upon transfer of the suture portion onto the suturing instrument 900.
- the lock release mechanism 4077 comprises a spring biased block 4079' that in its initial position 4079'A ( Fig. 17A ) supports the resilient member 4079 and prevents its movement in the proximal direction.
- the resilient member 4079 flexes to allow the distal portion 920 of the suturing instrument 900 to advance, as shown in Fig. 17A , and resilient member 4079 is thereafter engageable with the window 955 of the suturing instrument 900 to prevent retraction of the suturing instrument 900, as shown in Figs 17B (i), 17B (ii) .
- the block 4079' remains in its initial or locked position 4079'A substantially adjacent the resilient member 4079 to prevent bending of the resilient member 4079 in the proximal direction to prevent retraction of the suturing instrument 900 prior to loading of suture onto the suturing instrument 900.
- the spring biased block 4079' forming the lock release mechanism 4077, moves into its second or unlocked position 4079'B, as shown in Figs. 17C(i), 17c(ii) , where it no longer interferes with the movement of the resilient member 4079 allowing it to flex proximally, thereby permitting retraction of the suturing instrument 900.
- the cartridge includes a delay mechanism to delay transfer of the suture from the cartridge onto the suturing instrument until after the seat, defined by the rocker,is aligned with the suturing instrument 900. More specifically, the delay mechanism prevents actuation of the suture insertion mechanism to transfer the suture from the seat to the instrument prior to alignment of the seat with the suture passing member held within the proximal portion of the suturing instrument.
- the distal portion 920 of suturing instrument 900 is configured to interact with a bevel face of the rocker such as the first bevel face 4043 of rocker 4041 upon advancement of the suturing instrument 900 within the cartridge 4000 as shown, for example, in Figs 18Ai ), 18Aii).
- the rocker 4041 in Figs 188Ai)-18Bii) is shown in a partial breakaway view with the front half of the rocker 4041 being removed. This results in pivoting of the rocker 4041 from its first position 4041A, illustrated in Figs.
- An intermediate position of the rocker 4041 is illustrated in Figs. 18Bi ), 18Bii) during movement of the rocker 4041 from the first position 4041A towards its second position 4041B.
- the suturing instrument 900 Upon movement of the seat 4022 into the tissue receiving gap 942, the suturing instrument 900 is advanced distally in order to allow for the needle 930' to be positioned or docked adjacent the seat 4022, for example in abutting contact with the seat 4022 as shown in Fig. 18Cii ).
- the difference between the cartridge 4000 as shown in Figs. 18Ci) and 18Cii ) is that in Fig. 18Ci ) the needle 930' and the seat 4022 are at the point at which they are aligned but not yet docked, whereas in Fig. 18Cii ) the suturing instrument 900 has been advanced further to allow the needle 930' to dock with the seat 4022.
- the suture transfer or insertion mechanism is delayed until such alignment occurs, and is then actuatable to transfer or load the suture portion from the seat 4022 onto the suturing instrument 900.
- the delay mechanism for delaying actuation of the suture insertion mechanism comprises a delay interlock 4095 mounted on the suture insertion mechanism which, in the illustrated example, comprises a push rod hub 4057' coupled to a push rod 4053, as shown in Figs. 13C and 13D .
- the delay interlock 4095 comprises a resilient member 4096 coupled to or integral with the push rod hub 4057', the resilient member 4096 (such as a push rod hub flex arm) being configured to co-operatively engage a protrusion 4097 coupled to the rocker 4041 ((Also shown in Fig. 13C and Fig. 18C(ii) ), whereby the protrusion 4097 can be understood to be indirectly coupled to the seat 4022).
- the resilient member 4096 is positioned distal to the protrusion 4097 in a first, or unactuated, state of the suture insertion mechanism.
- the suturing instrument 900 may be advanced distally within the cartridge 4000, causing the push rod hub 4057' to contact a spring hub 4100 and to thereby apply a force to hub 4100 (and, consequently, to spring 4103) as the instrument 900 is further advanced.
- spring hub 4100 is pushed distally and protrusion 4097 is advanced beyond resilient member 4096, such that resilient member 4096 is positioned proximal to the protrusion 4097.
- the suture insertion mechanism is now in its second or actuated state resulting in the push rod hub 4057' moving within the push rod hub cavity 4057 shown in Fig. 13.G due to the biasing force of spring 4103 against hub 4100. Movement of the push rod hub 4057' then results in translation of the push rod 4053' coupled thereto to advance the suture portion, such as a suture end 502 comprising compressed suture, from the seat 4022 into or onto the needle 930'.
- actuation of the suture insertion mechanism, and consequent transfer of the suture is delayed until the delay interlock is positioned appropriately, which occurs following alignment of the seat with the needle 930'.
- Some examples additionally comprise one or more features to provide the user with an indication that the suture portion, such as the suture end 502 [shown, for example, in Fig. 13G ] has been transferred from the seat 4022 onto the suturing instrument 900.
- the cartridge 4000 comprises an indicator for indicating transfer of the suture onto the suturing instrument 900.
- the indicator may comprise one or more of a tactile indicator, a visual indicator or an audible indicator.
- the indicator comprises a tactile indicator comprising a force release mechanism 4200 as shown in Figs. 18D(i) and 18D(ii) .
- a force release mechanism 4200 comprises a spring biased mechanism defined by the spring hub 4100 which itself comprises outwardly extending hub flex arms 4102 as well as a spring 4103.
- the force release mechanism 4200 provides an indication of a change in a force, which may be felt by the user, between the unactuated state of the suture insertion mechanism and the actuated state of the suture insertion mechanism as discussed hereinabove. More specifically, the force release mechanism 4200 is configured such that the user is able to feel a change in force once the push rod hub 4057' moves from its initial unactuated position shown in Fig. 18D(i) towards its actuated position as shown in Fig. 18D(ii) for transferring the suture portion from the seat 4022 into the needle 930'.
- the suturing instrument 900 is operable to be advanced distally. As illustrated in Figs. 18D(i) and 18D(ii) , further advancement causes the outwardly extending hub flex arms 4102 of the spring hub 4100 advance beyond ledges or ribs 4102' defined by the cartridge housing 4010' causing the spring 4103 to compress. The movement of the hub flex arms 4102 beyond the ledges 4102', combined with the concurrent compression of the spring 4103, results in a force differential that is felt by the user handling the instrument 900, as there is a reduction in resistance force upon further advancement of the suturing instrument 900.
- the force release mechanism 4200 additionally provides an audible indication as the hub flex arms 4102 ride over the ledges 4102', whereby the force release mechanism additionally defines a snap release mechanism.
- the tactile and/or audible indicators are not activated immediately upon transfer of the suture portion; rather, the indication is delayed until the instrument is further advanced within the cartridge.
- the cartridge 4000 comprises a delay mechanism to delay activation of the indicator (for example for a predetermined time period) following loading of the suture portion from the cartridge onto the suturing instrument 900. This provides a safety and security feature in terms of ensuring that the suture has been loaded prior to an indication being provided to the user to indicate transfer of the suture portion. In other words the indication provides a safety factor to account for dimensional and force variabitlity.
- a visual indicator comprising a button 4106 including a spring biased mechanism 4106'.
- the spring biased mechanism is configured to cause the button 4106 to be released, allowing it to move from its initial position 4106A [ Fig. 18C (ii) ] to its second position 4106B [ Fig. 18D(ii) ], upon transfer of the suture portion onto the suturing instrument 900, thereby providing a visual indication of the suture transfer.
- the visual indicator 4106 cooperates with the force release mechanism 4200, whereby visual indicator 4106 is released into its second position 4106B upon movement of the force release mechanism 4200. For example, as illustrated in Figs.
- the indicator is automatically activated upon loading of the suture portion from the cartridge onto the suturing instrument.
- the indicator button 4106 additionally provides an audible indication to the user as the bar 4108 is released from engagement with horizontal bar 4107'.
- the indicator button 4106 may form the primary mechanism for providing an audible indication.
- the suturing instrument may then be removed from the cartridge housing as shown in Figs. 18E and 18F .
- the rocker 4041 enables unimpeded retraction of the suturing instrument by being made to pivot out of the way of the suturing instrument 900 to return to its initial position 4041A.
- the seat 4022 is moveable out of the tissue receiving gap 942 of the suturing instrument 900.
- a cartridge 4000 is provided that additionally allows for loading a pre-tied knot onto a suturing instrument 900, for example by allowing loading, mounting or transfer of a knot deployment mechanism or knot slider 4030 onto the suturing instrument 900.
- the cartridge additionally provides for a knot deployment mechanism or knot slider 4030 (that for example has a pre-tied knot mounted there-about) to be mounted onto the suturing instrument 900 to enable retraction of the knot deployment mechanism or knot slider 4030 along with suturing instrument 900.
- the knot deployment mechanism or knot slider 4030 is detachably coupled to the cartridge housing sleeve 4011' by a knot slider release mechanism 4060.
- the knot slider release mechanism comprises a resilient member, for example a snap arm 4062, as shown, where the resilient member is configured to release the knot slider 4030 from the housing sleeve 4011' of the cartridge housing 4010' upon insertion of a suturing instrument 900 there-through.
- the knot slider 4030 and the cartridge housing sleeve 4011' together form the cartridge housing 4010'.
- the snap arm 4062 provides flexibility and allows the knot slider 4030 to pivot up and down and bend left and right as the suturing instrument 900 is advanced through an opening or chamber within the knot slider 4030 and is guided into ribs defined by the cartridge housing sleeve 4011' to be guided into the rocker 4041.
- the knot slider 4030 is releasable from the snap arm 4062 upon advancement of the suturing instrument 900 within the cartridge.
- the knot slider 4030 is releasable from the snap arm 4062 upon alignment of the seat 4022 within the tissue receiving gap 942 of the suturing instrument 900.
- the knot slider 4030 is decoupled from the housing sleeve 4011' and remains mounted on the suturing instrument to enable the knot slider 4030 to be retracted along with the suturing instrument 900.
- the knot deployment mechanism or knot slider 4030 additionally comprises a feature for reducing the risk of insertion of the suturing instrument 900 by the user in an upside-down, or inverted, configuration.
- the knot slider 4030 comprises an instrument obstructing feature such as an interlock 4020' comprising an arm 4020 having a closed configuration 4020A and an open configuration 4020B.
- the interlock arm 4020 is configured to be initially in the closed configuration 4020A for preventing advancement of an inverted suturing instrument 900 into the cartridge [such as cartridge 4000 disclosed herein above]. As illustrated in Fig.
- the interlock 4020' such as the interlock arm 4020 remains in its closed configuration 4020A preventing further advancement of the suturing instrument 900 within the cartridge 4000. More specifically, the interlock 4020' is configured to engage with the flat face 921 of the suturing instrument 900. The flat face 921 of the suturing instrument does not cooperate with the interlock arm 4020 in a manner which allows the interlock arm 4020 to move into its second or open position 4020B. As such, the interlock arm 4020 remains in its closed configuration 4020A impeding advancement of the inverted suturing instrument 900.
- the interlock 4020' such as the interlock arm 4020 is operable to permit advancement of the suturing instrument 900 when it is advanced in its regular or nominal configuration with the instrument 900 being positioned in the right-side up configuration, as shown in Fig. 19A .
- Fig. 19B as the suturing instrument 900 is advanced further through the knot slider 4030, the distal portion 910 of the suturing instrument 900 engages with the interlock arm 4020, thereby moving it into its open configuration 4020B allowing further advancement of the suturing instrument 900 within the cartridge 4000.
- the interlock arm 4020 is configured to engage with the bevel face 923 of the suturing instrument 900 to cause the interlock arm 4020 to move into the open configuration 4020B.
- the obstructing feature such as an interlock 4020'
- the knot slider 4030 is defined by the knot slider 4030.
- a cartridge 4000 is provided where the interlock 4020' is defined by and forms a part of the cartridge housing sleeve 4011' instead of the knot slider 4030 [e.g. as shown in Figs. 21C and 21D ].
- the interlock arm 4020' is formed integrally with the housing sleeve 4011'.
- the interlock arm 4020' may be detachably coupled to the housing sleeve 4011' via a press-fit engagement therewith, for example as shown in Fig. 21D .
- the interlock arm 4020 comprises a pivoting connection forming a pivot arm.
- the pivot arm is held in frictional engagement with a portion of the knot slider 4030, such as the external knot slider 4010y of the cartridge housing 4010'.
- the pivot arm is operable to maintain closed configuration 4020A by, for example, a component 5000, as shown in Fig. 21E .
- the component may comprise an elastomeric gasket such as an O-ring.
- the obstructing feature defines an obstruction feature resilient member, i.e. an alternative embodiment to an interlock arm 4020.
- Figs. 21A(i) and 21A(ii) illustrate the alternate interlock arm in its initial closed position 4020A
- Figs. 21B(i), 21B(ii) illustrate the alternate interlock arm 4020 in its second or open position 4020B.
- the interlock 4020' such as interlock arm 4020 is configured to co-operate with a lock 4040 within the cartridge 4000 which hold the interlock arm 4020 in its open configuration 4020B to allow the interlock arm 4020 to remain in the open configuration 4020B.
- the lock 4040 comprises a friction-fit mechanism comprising resilient friction tabs 4040'.
- the lock 4040 comprising resilient tabs 4040' is further illustrated in Figs. 20A and 20B which shows an interlock 4020' comprising a button 4020" .
- the button 4020" is moveable from its first closed configuration 4020"A shown in Fig. 20A , to its second open configuration 4020"B, shown In Fig. 20B , upon advancement of the suturing instrument 900 in its nominal or right side up configuration, within the cartridge.
- the button 4020" is then held in its second open position 4020"B by the resilient tabs 4040'.
- the button 4020" may be spring-biased.
- the knot slider 4030 once mounted on the suturing instrument 900, is operable to be releasably coupled to a handle of the suturing instrument. Knot slider 4030 is further releasable therefrom to slide distally along the instrument proximal portion 910 during use to enable the pre-tied knot mounted about the knot slider 4030 to be deployed therefrom.
- the knot slider 4030 comprises an attachment mechanism for slidably engaging with the suturing instrument 900.
- the attachment mechanism comprises a tail hook or knot slider arm 4034 is slidable along a portion of the suturing instrument 900 such as the window 965 of the suturing instrument 900.
- the knot slider arm 4034 is received within a groove within an inner slider 4030x (that is held within the outer slider 4030y) and slidable therein to be extendable therefrom.
- the knot slider arm 4034 is initially in its retracted configuration 4034A as shown in Fig. 22A , where it is held within the knot slider 4030.
- the knot slider arm 4034 is slidable to move into its extended position 4034B and extends out from the knot slider 4030, as shown in Fig. 22C , and engages with a distal wall 965' of the window 965 to stop the knot slider 4030 such that it is positioned over the tissue receiving gap 942.
- the knot slider 4030 comprises a cover arm 4038 and slidable knot slider arm 4034 engages the distal wall 965' to allow the cover arm 4038 be positioned over the tissue receiving gap 942 to allow the cover arm 4038 to deflect inwards to deploy the pre-tied knot distal to the suturing instrument 900, as illustrated in Fig. 22D .
- a distal portion 4034d of the tail kook is relatively thinner than a proximal portion 4034p of the knot slider arm 4034 so that it minimizes the risk of the knot slider am 4034 interfering with the suturing instrument 900 upon advancement of the suturing instrument 900 within the knot slider 4030.
- the proximal portion 4034p is wider than the distal portion 4034d to facilitate engagement of the knot slider arm 4034 with the suturing instrument 900.
- the inner slider Fig. 22B of the knot slider 4030 comprises a suture housing 4067' for storing suture.
- the suture housing comprises tubing that is wound about a portion of the knot slider such as a slider central post 4067.
- the central post 4067 defines a groove 4067' for holding the suture tube.
- the tubing comprises PTFE (Polytetrafluoroethylene) such as TEFLONĀ®.
- the knot slider 4030 defines a channel 4014 for receiving the suturing instrument 900 therein.
- the inner slider 4030x of the knot slider 4030 comprises a suspension spring such as a circumferential O-ring mounted about the channel 4014 in order to facilitate movement of the knot slider 4030 along the suturing instrument 900.
- the O-ring comprises silicone. The O-ring provides shock absorption along the top and bottom of the suturing instrument 900 and facilitates sliding of the knot slider 4030 by decreasing the overall sliding force by allowing the suturing instrument 900 to be in sliding contact with the O-ring. As such the O-ring allows for easier deployment force and reduces the force of sliding and further allows the movement of the knot slider 4030 to be more tolerant and less sensitive to bumps.
- Example 5 thus includes various alternatives to features described above and/or additional features not previously mentioned including but not limited to: movement of the magazine, for example the rocker, alignment of the seat and/or rocker, reversibility-prevention features when suture has not been loaded, coupling of the rocker to the push-rod hub, indicator for indicating loading or transfer of suture onto the suturing instrument, interlock to prevent insertion of the suturing instrument in an incompatible orientation and features related to the knot slider.
- a cartridge 6000 having a housing 6010' for loading suture onto a suturing instrument 900 comprising a suture passing member such as needle for example that is held within the device proximal portion 910.
- the cartridge 6000 comprises a magazine 6041 defining a seat 6022 for holding an end of the suture.
- the seat 6022 is structured and configured to allow a suture passing member such as a needle to be advanced over the suture end to capture the suture end.
- the magazine 6041 is moveable from the first position 6041A into its second position 6041B as shown in Figs 23C(i) and 23C(ii) in order to align the seat 6022 within the tissue receiving gap 942 of the suturing instrument 900.
- the seat 6022 is moveable into alignment with the suture passing member held within the device proximal portion 910.
- the seat 6022 is laterally moveable with the magazine 6041 being pivotable to move the seat 6022 into alignment with the suture passing member.
- the magazine 6041 defines an alignment feature for aligning the seat 6022 with the suture passing member upon insertion of a suturing instrument within the cartridge 6000.
- the distal tip 920 of the suturing instrument 900 moves a seat interlock 6044 which for example comprises a pin which prevents movement of the seat 6022 prior to insertion of the suturing instrument 900 within the cartridge 6000 [ Fig. 23B(i), Fig. 23B(ii) ]. More specifically, as the suturing instrument 900 is advanced, the distal portion 920 of the suturing instrument moves the seat interlock 6044 distally which releases the magazine 6041 causing it to pivot into its second position 6041B [ Fig. 23C(i), Fig. 23C(ii) ].
- the seat interlock 6044 is configured to be automatically disengaged upon advancement of the suturing instrument 900 within the cartridge 6000 to allow the seat 6022 to be automatically brought into alignment with the suture passing member 930' upon disengagement of the seat interlock 6044.
- the seat 6022 comprises a seat block 6024 defines a seat cavity 6022' for holding the suture end 502 in frictional engagement therein, as shown in Fig. 23D .
- the seat comprises a seat post 6026 adjacent the seat cavity 6022' for retaining the suture end 502 upon advancement of the suturing instrument within the cartridge.
- the seat block 6024 is operable to be moved away from the suture passing member such as the needle 930' upon advancement of the needle 930' for example upon partial actuation of the trigger of the suturing instrument 900, to allow capture of the suture end by the needle 930', as shown in Fig. 23E .
- the seat post 6026 functions to keep the suture end 502 in place by preventing the suture end 502 to be moved distally as the seat block 6024 is moved as shown in Fig. 23E .
- the seat 6022 defines a recess 6028 adjacent the seat cavity 6022' for receiving the suture passing member 930', as shown in Fig. 23D .
- the recess 6028 defines a bevel face configured for abutment with a bevel face of the suture passing member such as needle 930'.
- the suturing instrument 900 is then retracted with the distal portion 920 of the suturing instrument 900 interacting with a bevel 6045 of the magazine causing it to move into its first position 6041A allowing the suturing instrument 900 to be retracted.
- the cartridge may comprise an alignment mechanism described in Figs. 12A-12F .
- one or more of the seat 6022 and the cartridge housing comprise a medical grade polymer such as ABS.
- the cartridge comprises a medical grade metal.
- the seat 6022 comprises a metal such as stainless steel.
- the cartridge 700o comprises a pivoting magazine 7021 that comprises two arms 7041, 7042 with one of the arms 7042 defining the seat 7022.
- the instrument As the instrument is inserted within the cartridge 7000 as shown in Fig. 24A(i) , it pushes arm 7041 out of the way to swing arm 7042 within the tissue receiving gap of the suturing instrument 900 to align the seat 7022 with the suturing instrument 900, as shown in Fig. 24A(ii) .
- Figs. 24B(i) and 24B(ii) illustrate a cartridge 7000 with a pivoting magazine 7021.
- the cartridge 7000 additionally comprises an outer sleeve 7000' that is moveable distally such that bevel 7001 pushes the seat 7022 to pivot it within the tissue receiving gap 942. Once the outer sleeve 7000' is pulled proximally the bevel 7002 engages arm 7041 to pivot the magazine 7021 to move the seat 7022 out of the tissue receiving gap 942.
- a cartridge 8000 is provided that comprises a cam 8041 that is moveable to move a seat 8022 within the tissue receiving gap 942.
- Example 6 includes various alternatives to features described above and/or additional features not previously mentioned including but not limited to: movement of the magazine, alignment of the seat and/or magazine, specifically mechanisms to enable movement of the magazine to align the seat within the tissue receiving gap of the suturing instrument, and additionally one or more examples of a cartridge that are configured to allow a suture passing member of a suturing instrument to capture an end of the suture.
- two events or functions typically occur: (1) alignment of the suture portion held within the cartridge with a suture receiving feature within the surgical suturing instrument or the suture passer and (2) insertion or transfer of the suture portion into the suture receiving feature within the suturing instrument or suture passer.
- a cartridge configuration is provided that is fully automated - requiring a single "pump-action" user step while completing all mechanical events to load the suture into the suturing instrument.
- a user step to actuate the suture passer trigger to load the suture may not be required.
- the suture cartridge device includes a pre-tied knot and integrated features to store the Suture limbs, which may reduce the required user attention to manage the Suture and may help eliminate the complex knottying step required by existing devices.
- a cartridge configuration is provided that contains a detachable knot slider containing a pre-tied knot and storage of the suture.
- the cartridge has a side slot for securing the Suture out of the way of the suture passer shaft when it is inserted into the cartridge.
- the cartridge may be constructed of Medical Grade plastic/metal components such as ABS for the cartridge base, seat, suture lock, interlocks and other mechanical components.
- stainless steel may be utilized for the seat, silicone in O-rings for holding the Suture.
- the suture contained in the cartridge may comprise polyethylene.
- examples as outlined herein allow the suture end to be positioned or constrained in the following degrees for alignment to occur in order to allow the suture to be loaded onto the suturing instrument.
- the suture portion is positioned such that it position is maintained along the X axis (lateral direction), Y-axis (vertical or up and down directions), Z axis (linear or longitudinal direction) as well along the Y- rotational axis and the Z rotational axis. Further details of the alignment mechanism are provided herein below.
- a magazine defining a seat is provided that is operable to be mechanically interlocked with the suture passer such that when the suture cartridge is inserted over the suture passer and pressed, the magazine and thus the seat is configured to rotate down, aligning the suture portion within the seat with the suture passer.
- the magazine defining the seat grabs onto the suture passer to align the suture portion in the X-axis and Y-axis and constrain X-rotation and Y-rotation of the Suture.
- the seat mates with and is pushed up to the suture passer to align the suture in the Z-axis.
- the magazine comprises a feature to hold/lock the suture to the side and align it with the suture slot in the suture passer shaft.
- a cartridge base interlock is provided in the form of a button that the user presses to allow the cartridge base to move.
- some examples provide a a suture lock using which the suture is manually unlocked by the user at a specified time.
- examples provide an alignment mechanism that comprises a magazine defining a seat that automatically pivots into place from the top to align the suture with the suture passer.
- the magazine is mechanically interlocked with the suture passer such that when the cartridge containing the magazine that defines the seat, is inserted onto the suture passer, the geometry of the suture passer presses a bevel on the magazine and causes the magazine and thus the seat defined thereby, to pivot into place.
- the seat is a part of a rocker as outlined in further detail herein above as discussed in examples 3 and 4.
- aligning of the seat using a pivoting rocker is beneficial when the suture passer has complex features around the site at which the suture is loaded (or otherwise) limiting the alignment of the seat to be purely linear.
- the rocker is beneficial when an automatic (without desire of user interaction to align the seat) mechanism is desired. This is because it may generally be easier to move a pivoting part through a desired displacement on an arc than a sliding part through a desired displacement along an axis. (this is due to reduced friction/binding and increased mechanical advantaged gained in a pivoting system).
- the seat is configured such that it is defined by a tubular member (seat defining member or projection) that extends out from the body of the magazine such as the rocker and is receivable into the hole on the suture passer and up against the feature in the suture passer (such as the suture passing member such as the needle) into which the suture is loaded.
- the projection that extends into the hole in the suture passer has an interference fit with the inner walls of the hole to align the seat/suture within a repeatable tolerance zone relative to the feature on the suture passer that receives the suture. Having this interference fit may reduce the tolerance stack-up of misalignment.
- the magazine is configured such that the magazine and thus the seat defined thereby aligns perfectly with the corresponding features on the suture passer such that the mechanism cannot possibly ever jam because the geometry does not allow that to happen.
- the magazine is configured such that it has an interference fit with reference features on the suture passer to positively align the seat defining member or projection within a repeatable tolerance zone relative to the hole that contains the suture passing member such as the needle on the suture passer. Having this interference fit may reduce the tolerance stack-up of misalignment.
- an alternative seat is provided, the seat containing a cavity that has an interference fit with the outer diameter of the needle.
- the needle is then held in the "outā position during shipping with a lock such as cam lock that hooks the needle, or a trigger lock that hold the trigger slightly depressed.
- a lock such as cam lock that hooks the needle, or a trigger lock that hold the trigger slightly depressed.
- the user is required to press the trigger to cause the needle to move out and into the seat cavity before the suture is pulled.
- having the "Needle-out" configuration may have a reduced tolerance stackup of misalignment compared to the "Needle-In" configuration.
- some examples may provide a seat that pivots inwardly from the side.
- a seat may be provided that slides from the side(s) or from the top.
- a magazine may be provided that is pushed into place by the user at a specified time to push the seat into place.
- a button may be pressed to enable the rocker to rotate.
- the alignment feature comprises a moveable seat as outlined above.
- the seat is moveable relative to the base.
- the seat is moveable relative to the chamber defined by the housing of the cartridge.
- the seat may be automatically moveable (upon advancement of the suturing instrument within the cartridge).
- a fully automatic mechanism is provided for aligning and transferring suture.
- a more simplified mechanical design may be provided that reduces the number of steps that the user is required perform in order to load the suture.
- the mechanical design provides one or more steps that the user is required to perform to load the suture.
- a push rod interlock may be provided in the form of a button that the user presses in order to allow the push rod to move to push the suture end into the suturing instrument.
- the embodiment provides for automatic decoupling of the knot slider.
- the Knot Slider may be manually decoupled from the Cartridge Base by the user at a specified time.
- a visual indicator window may be provided that shows the user when the Lobster has been loaded and when the suture Knot Slider can be released.
- a similar mechanism in the form of a visual indicator window may be provided that shows the user when the Lobster has been loaded and when the suture lock may be released.
- a cartridge that provides an additional means for providing an indication for when the suture has been loaded into the suture passing member.
- an interlock in the seat i.e. a seat interlock may be provided which senses when the suture has left the seat.
- the cartridge may provide clear or see-through components so the user can physically see when the Suture has been loaded.
- optical sensors may be provided that detect when the suture has been loaded.
- a fixed tail hook instead of a sliding tail hook on the knot slider a fixed tail hook may be provided.
- examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge defining a path for insertion thereto and withdrawal therefrom of the suturing instrument, the cartridge comprising:a seat for releasably holding a portion of a suture; and a translation mechanism for moving the seat out of a path of a suturing instrument inserted into the cartridge to allow for withdrawal of the suturing instrument from the cartridge.
- a cartridge operable to move the seat out of the way of the suturing instrument following loading of the suture so that the suturing instrument can be withdrawn.
- the seat is moveable to align with a portion of the suturing instrument to allow for loading of the suture, such that the seat is moveable between: a first state whereby it is not obstructing a path of the suturing instrument to permit insertion of the suturing instrument into the cartridge; a second state in which the seat is moved into alignment with a portion of the suturing instrument, such as a tissue receiving gap described above, to allow for loading the suture portion onto the suturing instrument; and a third state whereby the seat is moved out of the path of the suturing instrument to permit substantially unobstructed withdrawal of the suturing instrument from the cartridge.
- a cartridge include a magazine comprising the seat.
- movement of the magazine, and thereby the seat, between the various states may be accomplished via a rotational mechanism (such as in examples 9 and 10 where the magazine comprises a rocker) or the movement may be accomplished via a linear mechanism such as a spring biased mechanism, for example as illustrated in Example 2 above.
- a method for loading a suture onto a surgical suturing instrument the suture comprising suture loops and terminating in a suture end.
- the method involves mounting the suture loops onto a surgical suturing instrument positioned through the suture loops.
- the suture end is aligned with the suture receiving passage of the suture passing member and suture end is transferred to the suture receiving passage of the suture passing member.
- the step of aligning the suture end may involve restraining the suturing instrument with respect to the suture end.
- the suture end may be aligned by moving the suture end with respect to the suturing passing member.
- the step of aligning the suture end may comprise moving the suture passing member with respect to the suture end.
- the method of loading the suture onto the suturing instrument is performed using a suture loading apparatus such as a cartridge.
- the cartridge may be used to both mount suture loops onto the surgical instrument and to align the suture end with the suture receiving passage of the suture passing member.
- a method for suturing within an inter-vertebral disc.
- the method involves using a cartridge to load suture onto a suturing instrument, and then using the surgical suturing instrument to deliver the suture into the inter-vertebral disc.
- the cartridge is used to load suture at the point of use, for example by a physician just prior to using the suturing instrument within a patient.
- the suturing instrument is used to pass or insert suture into a region of tissue surrounding a defect within the inter-vertebral disc and approximating the defect using the suture.
- approximating the defect involves forming a loop of suture around the defect using the suture to provide a 360 degree approximation of the defect.
- a means is provided to secure the suture within the inter-vertebral disc such as knot.
- the knot comprises a pre-tied knot and is deployed after the step of approximating the defect.
- the cartridge provides a pre-tied knot.
- the method of loading the suture onto the suturing instrument is performed using a suture loading apparatus such as a cartridge. More specifically with reference now to Figs. 1A-1F , a cartridge 100 is provided for loading suture 500 onto the suturing instrument 900.
- the suture 500 comprises suture loops or pre-tied knot 502 that opens into a service loop 501 comprising a tug loop 507 that terminates in the suture end 504 held within the seat 122.
- the distal tip 920 of suturing instrument 900 is inserted the housing 10' through the channel 14 within the chamber 10, such that it is positioned through the suture loops or pre-tied knot 502 mounted on the housing 10'.
- the distal tip 920 of the suturing instrument 900 is then advanced distally through and past the channel 14 so that the housing 10' is now mounted onto the proximal portion or shaft 910 of the suturing instrument. Since the base 120 is flexibly coupled via flexible tube 152 to the housing 10', this allows the cartridge base 120 to be positioned to the side and out of the way (away from the longitudinal axis of the suturing instrument 900) to permit the suturing instrument 900 to be advanced.
- the flexible tube 152 bends to allow the cartridge base 120 to be kept off to the side from the path of the surgical suturing instrument 900 as it is advanced through the housing 10'.
- the suturing instrument 900 is positioned such that the distal tip 920 and the neck portion 940 as well as the tissue receiving gap 942, are positioned distal to the housing 10'.
- the restraint 25 comprises a locking recess 125 that corresponds to the shape of the suturing instrument 900. Specifically it is a recess that is shaped to accommodate the neck portion 940, and a segment of the proximal and distal portions 910, 920 of the suturing instrument 900.
- the cartridge base 120 is then snapped to the suturing instrument 900.
- the suturing instrument 900 is received within the locking recess 125 such that the base 120 press-fits around it.
- the locking recess 125 functions to restrain the suturing instrument to help align the seat 122 and thus the suture end 504 held within the with the seat 122 with the suture receiving passage 932 of the suturing instrument 900.
- the cartridge base 120 additionally comprises an alignment recess 130 adjacent the seat 122 to further assist in aligning the seat 122 with the suture receiving passage 932 of the suturing instrument 900.
- the alignment recess 130 is dimensioned to receive the suture passing member 930 such as needle 930'.
- the suture is routed through the base slot 128 that is in communication with the seat 122, as shown in Fig. 1B .
- the base slot 128 is aligned with the longitudinal opening 928 within the instrument proximal portion 910 and with the slit 938 within the needle 930'.
- the suture tug loop 507 that exits the cartridge 100 is then pulled (proximally) by tugging on it for to draw the suture end 504 from the seat 122 and into the aligned suture receiving passage 932 of the suture passing member 930 to position the suture end 504 therein.
- the suture retention pin 165 holds a portion of the tug loop 507 to prevent the service loop 501 from being pulled out of the suture spool 160.
- the suture retaining component165 may then be removed, releasing the suture 500.
- the trigger may be released at this point.
- the flexible tube 152 is detached from the housing 10', decoupling the base 120 from the housing' 10'.
- the cartridge base 120 can be removed from the suturing instrument by unsnapping the cartridge base 120 from the surgical suturing instrument 900. More specifically, the suturing instrument 900 is decoupled from the locking recess 125 of the base 120.
- the suturing instrument 900 is then used to pass suture 500 through a region of tissue for example within an intervertebral disc of a patient's body to apply suture thereto, for example to close a defect within the inter-vertebral disc.
- the suturing instrument 900 is then pulled such that the suture 500 held within suture storage such as suture spool 160 is payed out.
- the tension within the suture 500 then decouples the housing 10' from the instrument proximal portion or shaft 910, allowing the housing 10' to slide distally along the suturing instrument 900 and deploy the pre-tied knot 502 within the inter-vertebral disc to secure the suture 500 passed through the disc.
- the cartridge base 220 may be removed from the surgical instrument and discarded.
- a method for loading suture 500 onto the suturing instrument 900 using a cartridge 400, as shown in Figs. 2A-2C .
- the cartridge comprises a housing 10' (for example of the type previously described) that is detachably coupled to the base 420.
- the cartridge is loaded onto the suturing instrument 900 by advancing the instrument 900 through the housing 10' and then through the instrument receiving recess 425' within the cartridge base 420 with the spring mounted magazine 421 (or interlock 421') being initially positioned in its first or initial position 421A, as shown in Fig. 4B .
- the cartridge 400 axially receives (or in other words permits axial advancement of) a portion of a suturing instrument 900 relative to the base in order to load the suture onto the suturing instrument 900.
- the cartridge 400 permits loading suture onto the surgical instrument 900 by allowing the surgical instrument 900 to be received axially through the cartridge 400.
- the suturing instrument 900 may be advanced distally through the cartridge 400 or the cartridge 400 may be moved proximally along the suturing instrument).
- the method provides for front end loading of the suturing instrument 900' using the cartridge 400.
- a tapered section of the distal tip 920 engages a slant or incline 923 of the interlock 421' automatically moving the magazine 421 (and thus the seat 422) downwards and into the tissue receiving gap 942 of the suturing instrument 900 to align the seat 422 (and the suture end 504 held therein) with the suture receiving passage 932, as illustrated in Fig. 2C .
- the spring mounted magazine 421 (or interlock 421') is now positioned in its second position 421B.
- the movement of the magazine 421 into the tissue receiving gap 942, and the distal advancement of the suturing instrument 900 through the magazine 421, further functions as a restraining feature to lock or restrain the suturing instrument 900 with respect to the cartridge 400.
- the suturing instrument 900 is slid into the cartridge 400 until it stops.
- the projection 430 moves into the shaft 910, such that bevel 434 of the projection 430 abuts against the needle bevel 934. This helps align the seat 422 (and suture end 504 held releasably within the seat channel 424) with the suture receiving passage 932 of the suturing instrument 900.
- the magazine 321 ( Fig. 2C ) is automatically moved into its second position to align the seat 422 with the suture passing member 930 upon relative movement between the cartridge base 420 and the instrument 900.
- the housing 10' may be advanced proximally along the shaft 910 until it abuts against the instrument handle, decoupling the base 420 from the housing 910'.
- the base 420 can then be removed from the suturing instrument 900.
- the base 420 can be automatically detached as the instrument 900 is withdrawn proximally and magazine 421 moves into its initial position 421A.
- the pre-tied knot 502 on the housing 10' may be deployed in the manner described previously for cartridge examples 100, 200.
- a cartridge 1000 that permits axial loading of a suturing instrument 900 for example of the type described previously herein with reference to Figs. 3A-3O .
- the suturing instrument 900 particularly provides a challenge as the instrument 900 defines an instrument distal portion 920 and an instrument proximal portion 910 defining a tissue receiving gap 942 there-between, where the suture passing member 930 that is to be loaded with suture is held within the instrument proximal portion 910.
- the cartridge 1000 provides a means for aligning the suture with the suture passing member 930 by allowing the suture to remain out of the way of the advancing suturing instrument 900 to enable advancement of the instrument distal portion 920 without hindrance.
- the suture is kept out of the way of the suturing instrument 900 until the instrument distal portion 920 has advanced past the suture, allowing the suture to then be moved into the tissue receiving gap 942 thereafter to align the suture with the suture passing member 930 to transfer the suture therein.
- a method of use of the cartridge 1000 for facilitating loading of suture 500 onto a surgical suturing instrument 900, for example at the point of use.
- a pivoting seat 1022 such as that defined by the rocker 1041 facilitates axial loading by enabling the rocker 1041 to remain out of way of the path of the advancing suturing instrument 900 until the tissue receiving gap 942 is positioned within the rocker cavity 1027'.
- the cartridge 1000 enables the rocker 1041 to pivot down into the tissue receiving gap 942, such that the seat 1022 is positioned adjacent and aligned with the suture passing member 930 such as a needle 930'.
- the method provides for initially positioning the suturing instrument 900 within the cartridge 1000.
- the suturing instrument 900 is then passed axially through the cartridge 1000 to enable front end loading of the suturing instrument 900. More specifically, With reference to Figs 4A and 3C , the suturing instrument 900 is inserted into the opening 1016 within the housing 1010' and is guided by the beveled interior edge 1016' into the channel 1014 of the cartridge housing 1010' and advanced distally As outlined above, channel 1014 extends longitudinally through the housing 1010' and is in communication with the base recess 1025 formed within the base 1020, forming a restraint 25.
- the suturing instrument 900 As the suturing instrument 900 is advanced through the cartridge 1000, it extends from the channel 1014 into the instrument receiving groove 1025a of the recess 1025 within the base 1020 that is in communication with the channel 1014.
- the restraint 25 constrains or limits the movement of the suturing instrument 900 in the transverse (i.e. up and down) and lateral directions as well along a longitudinal path defined thereby.
- the restraint 25 enables the suturing instrument 900 to be advanced in sliding engagement therein to maintain the position to the suturing instrument 900 along a path that is in line with the final position of the seat 1022 to facilitate alignment therewith to enable transfer of suture into a portion of the suturing instrument.
- the suturing instrument 900 is then advanced further such that the distal portion or end 920 of the suturing instrument 900 exits recess 1025a of the base 1020. More specifically, in the illustrated embodiment as shown in Fig. 4A , as the suturing instrument 900 is advanced it passes through the instrument receiving groove 1025a of the base 1020 [Shown in Fig. 3E ] into the rocker recess 1027 of the base 1020, until it is received within the distal groove portion 1048 of the rocker 1041. As such the suturing instrument 900 is positioned adjacent the suture 500 held within the suture groove 1025b [Also shown in Fig. 3D ].
- the suture 500 is held within the cartridge 1000 such that the suture end 504 is held within the seat 1022 from where it exits into the pivot recess or cavity 1027 and is routed along the suture groove 1025b of the base recess 1025.
- the distal portion 920 of the suturing instrument 900 is initially received within the distal groove portion 1048 of the rocker groove 1044, with the rocker 1041 being in its initial or first position 1041A.
- the distal surface of the distal tip 920 contacts and engages the bevel surface 1043 of the groove 1044 along the rear wall of the of the distal groove portion 1048
- the instrument distal tip engages the bevel face 1043 exerting a force there-against to enable the rocker 1041 to move from its first position into its second position 1041B, as shown in Figs.
- the distal portion 920 of the suturing instrument 900 is advanced with a sufficient force to enable the rocker 1041 to disengage from a location within the rocker recess 1027 where it is held in place in its initial position 1041A, as shown in Fig. 4A , for example by frictional engagement or a tab.
- rocker 1041 once rocker 1041 is released from engagement, it starts to pivot down. As the rocker 1041 pivots into position the proximal portion 910 of the suturing instrument 900 is received into the proximal groove portion 1046. The pivotal movement of the rocker 1041 enables the suturing instrument 900 to be loaded axially by allowing the distal end 920 to advance past the seat 1022 of the rocker 1041 before the rocker 1041 pivots down into the tissue receiving gap 942 such that the seat 1022 is now positioned within the tissue receiving gap 942 of the suturing instrument 900. As shown in Fig.
- the surgical suturing instrument 900 is then continued to be advanced into the base 1020, until the suture passing member 930 such as the needle 930' is in abutting contact with the seat 1022. Once the needle 930' abuts the projection 1030, it halts the movement of the suturing instrument 900 with respect to and within the cartridge 1000. More specifically, as shown in Fig. 4D and earlier with reference to Fig.
- the bevel face 934 of the needle 930' is in abutting contact with bevel face 1034 of the projection 1030 that defines the seat 1022 such the needle slot 938 and the shaft slot 928 [behind the needle 930' and the projection 1030 that forms the seat 1022] are in line with and adjacent the seat slot 1028.
- the shaft slot 928 and the needle slot 938 are visible in Figs 1D and 1E , discussed earlier.
- a magazine in the form of a rocker 1041 is provided that is operable to be mechanically interlocked with the suturing instrument such that when the suture cartridge is inserted over the suturing instrument and pressed, the rocker 1041 is configured to rotate down, aligning the suture end 504 with the suturing instrument.
- the rocker 1041 grabs onto the suturing instrument 900 to align the suture end 504 in the X-axis (laterally) and Y-axis (transverse/vertical or up and down directions and constrains the rotation the suture end in the X and Y rotational directions. Furthermore, the rocker 1041 mates with and is pushed proximally up to the suturing instrument 900 to align the Suture in the Z-axis (linear or longitudinal directions).
- the interlock 1050 remains in its initial locked position 1050A which ensures that the base 1020 remains coupled to the housing 1010' as shown in Figs. 5A and 5C
- the interlock arms 1056 are positioned axially adjacent the locking arms 1026 of the base and prevent the movement of the base 1020 relative to the housing 1010'.
- the locking arms 1026 of the base 1020 are in engagement with the interlock arms 1056.
- the cartridge 1000 enables direct transfer of the suture end 504 into the needle 930' using the housing 1010'.
- the seat 1022 is in alignment with and adjacent the bevel face 934 of the needle 930' the suture end held in a force fit inside the seat 1022 can then be transferred into the needle 930' ( Fig. 3M and 4D ).
- the interlock 1050 is then moved from its locked position 1050A to its unlocked position 1050B to disengage the housing 1010' [which defines a suture transferring component 1011 as discussed previously herein] from the base to transfer the suture onto the suturing instrument 900.
- the housing 1010' and as such the suture transferring component 1011 defined thereby is detached from the base 1020 allowing the housing 1010' to be pulled back such that the suture end 504 is transferred into the needle 930', as shown in Fig. 7A .
- the detached base 1020 may be removed thereafter as shown.
- the cartridge 1000 of the present embodiment allows suture to be independently transferred from the cartridge 1000 into the suture passing instrument 900.
- the housing 1010' additionally provides for loading a partially pre-tied knot on the suturing instrument 900.
- the housing 1010' may then be removed.
- the housing may remain mounted on the instrument proximal portion 910 to retain the partially pre-tied knot and or excess suture on the suturing instrument 900.
- the suture lock 1060 may be disengaged to allow the housing 1010' and as such the suture transferring component 1011 defined thereby to be disengaged with the suturing instrument 900 after the suture end 504 has been loaded onto the suturing instrument 900.
- the suture 500 is routed through the suture lock engaging component 1062 of the housing 1010', and the suture lock 1060 is press fit in the suture lock engaging component 1062 thereby pressing the suture 500 between the teeth 1064 of the suture lock 1060 and corresponding teeth 1064' of the suture lock engaging component 1062, and as such the suture 500 is coupled to the housing 1010'.
- the lock is the moved into its second position 1060B as shown in Figs. 7D and 7F , moving the teeth 1064, 1064' out of engagement with one another and releasing the suture held therein.
- the housing 1010' and thus the suture transferring component 1011 may then be removed from the suturing instrument 900.
- examples provide a cartridge 1000 that provides a means to load suture into a suture passing instrument of the type as described herein (such as suturing instrument 900) having an instrument proximal portion 910 and an instrument distal end 920 defining a tissue receiving gap 942 there-between.
- the current embodiment additionally facilitates automatic alignment of suture 500 (for example end 504 of the suture 500) by allowing the rocker 1041 to pivot into the tissue receiving gap upon engagement with the instrument distal end 920 as it is being advanced into the cartridge 1000.
- a suture cartridge is provided that that exerts a force on the end of the suture to load it into the surgical suturing instrument or the suture Passer. All mechanical events achieved by the suture cartridge device are obtained in a single "pump' action performed by the user and in some examples may not require actuation of the suture passer (suturing instrument) trigger. ā In some such examples the single "pump' action maybe likened to that of a shotgun loading action.
- a suture cartridge that uses a pulling force on the end of the suture to load it into the suture passer as outlined in example 3 herein above.
- the pull method may be used to insert suture into a suture passer that would allow space for a generally straight-line pull of the suture in the direction of loading. In some situations the pull method may be used when it is required that the suture stay managed/in tension throughout the loading procedure.
- the seat locks onto a limb.
- the mechanical events to insert the suture occur in the following ways: (1) to apply the force to the end of the suture, the strand of suture is pulled in the middle by a means of grasping the strand with the Suture Lock. (2) To achieve relative motion between the suture and suture passer, the suture passer is fixed with respect to the suture, such that when the applied pulling force is exerted onto the Suture, the suture passer stays still and the suture moves towards and into the suture passer.
- the seat is also fixed with respect to the Suture, such that when the applied pulling force is exerted onto the Suture, the seat stays still and the suture moves away from and out of the seat.
- a pull insertion mechanism has a suture lock which is a piece that can move independently from the cartridge base and the suture passer that holds the suture proximally to the seat and is moved away from the seat, thus pulling the suture and creating the required force and relative motion.
- the suture lock automatically decouples from the cartridge base once the seat has fully aligned the suture (suture portion) with the suture passer. This is done by way of an interlock that prevents the Suture lock from moving relative to the cartridge base until the full alignment step has occurred (i.e. prevents the suture from being pulled before it is fully aligned).
- the pull insertion mechanism comprises a suture Lock that automatically unlocks from the suture once the suture (e.g. suture end) has been successfully loaded into the suture passer. As such unlocking of the suture allows the suture passer to then pass the suture freely.
- the unlocking is performed by way of an interlock which prevents unlocking to occur until the point at which the suture is successfully loaded into the suture passer.
- the suture lock interlock may be force/displacement based using a spring to ensure that a given amount of force is exerted on the suture to obtain a given displacement of the suture lock.
- the force may be calibrated to be much greater than the maximum theoretical/empirically derived force required to successfully load the Suture. Once this force is achieved, a certain displacement may also be achieved causing the interlock to unlock the suture.
- a pre-tied knot is provided on a knot slider which is integrated with a suture lock and houses the suture strands.
- the knot Slider remains on the suture passer after the suture cartridge is actuated to load the suture into the suture passer and functions to release the suture knot to the surgical site once the suture passer is used.
- a method of use of the cartridge 2000 for facilitating loading of suture 500 onto a surgical suturing instrument 900, for example at the point of use.
- a pivoting seat 1022 such as that defined by the rocker 1041 facilitates axial loading by enabling the rocker 1041 to remain out of way of the path of the advancing suturing instrument 900 until the tissue receiving gap 942 is positioned substantially within the rocker cavity 1027'.
- the cartridge 1000 enables the rocker 1041 to pivot down into the tissue receiving gap 942, such that the seat 1022 is positioned adjacent and aligned with the suture passing member 930 such as a needle 930'.
- the cartridge 2000 additionally provides a suture transferring component 2011 for transferring the suture end 504 from the seat 1022 into the suture receiving recess 932 of the suturing instrument 900.
- the cartridge 2000 additionally provides a knot slider 2030 that permits loading of a pre-tied knot 502 onto the suturing instrument 900.
- the method provides for initially positioning the suturing instrument 900 within the cartridge 2000.
- the method is described in reference to the advancement of the suturing instrument 900 within the cartridge 2000.
- the cartridge 2000 is loaded onto the suturing instrument 900 via a proximal movement of the cartridge 2000 over the suturing instrument 900. As such the suturing instrument 900 the cartridge 2000 are moveable relative to one another.
- the cartridge 300 is loaded proximally over the suturing instrument 900, with the suturing instrument 900 being passed axially through the cartridge 3000 to enable front end loading of the suturing instrument 900. More specifically, the suturing instrument 900 is inserted through the chamber 1010 of the housing 1010' defined by the knot slider 2030. The suturing instrument is guided by the beveled interior edge 2016' of the opening 2016 into the channel 2014 of the knot slider ( Fig. 8D and Fig.9A [iii] ), and as such mounting the knot slider 2030 and the pre-tied knot mounted onto the suturing instrument.
- the base recess 2025 and the channel 1014 function as the restraint 25 to constraint or limit the movement of the suturing instrument 900 in the transverse (i.e. up and down) and lateral directions as well along a longitudinal path defined thereby.
- the restraint 25 enables the suturing instrument 900 to be advanced in sliding engagement therein to maintain the position to the suturing instrument 900 along a path that is in line with the final position of the seat 1022 to facilitate alignment therewith to enable transfer of suture into a portion of the suturing instrument.
- the instrument receiving groove 2025a guides the suturing instrument into the rocker recess 1027.
- the suture 500 is held within the cartridge 2000 such that the suture end 504 is held within the seat 1022 from where it exits into the pivot recess or cavity 1027 and is routed along the suture groove 1025b of the base recess 1025.
- the suturing instrument 900 is positioned adjacent the suture 500 held within the suture groove 1025b, also shown in ( Figs.8F[i], 8F[ii] ).
- the distal portion 920 of the suturing instrument 900 is initially received within the distal groove portion 1048 of the rocker groove 1044, with the rocker 1041 being in its initial or first position 1041A.
- the instrument distal tip 920 contacts and engages the bevel surface 1043 along the rear wall of the of the distal groove portion 1048 exerting a force there-against to move the rocker 1041 to rom its first position 1041A into its second position 1041B, as shown in Figs.9B[i],[ii] .
- the distal portion 920 of the suturing instrument 900 is advanced with a sufficient force to enable the rocker 1041 to disengage from the friction tab 2029 within the rocker recess 1027 where it is held in place in its initial position 1041A, as shown in Fig.9A[i] .
- rocker 1041 once rocker 1041 is released from engagement within the rocker recess 1027, it starts to pivot down into the rocker cavity 1027'. As the rocker 1041 pivots into position the proximal portion 910 of the suturing instrument 900 is received into the proximal groove portion 1046.
- the pivotal movement of the rocker 1041 enables the suturing instrument 900 to be loaded axially by allowing the distal end 920 to advance past the seat 1022 of the rocker 1041 before the rocker 1041 pivots down into the rocker cavity 1027' that corresponds to the tissue receiving gap 942 such that the seat 1022 is now positioned within the tissue receiving gap 942 of the suturing instrument 900.
- a magazine in the form of a rocker 1041 is provided that is operable to be mechanically interlocked with the suturing instrument such that when the suture cartridge is inserted over the suturing instrument and pressed, the rocker 1041 is configured to rotate down, aligning the suture end 504 with the suturing instrument.
- the rocker 1041 grabs onto the suturing instrument 900 to align the suture end 504 in the X-axis (laterally) and Y-axis (transverse/vertical or up and down directions and constrains the rotation the suture end in the X and Y rotational directions. Furthermore, the rocker 1041 mates with and is pushed proximally up to the suturing instrument 900 to align the suture in the Z-axis (linear or longitudinal directions).
- the surgical suturing instrument 900 is then continued to be advanced into the base 2020, upto/until the suture passing member 930 such as the needle 930' is in abutting contact with the seat 1022. Once the needle 930' abuts the projection 1030, it halts the movement of the suturing instrument 900 with respect to and within the cartridge 1000. More specifically, as shown in Fig. 4D and earlier with reference to Fig.
- the bevel face 934 of the needle 930' is in abutting contact with bevel face 1034 of the projection 1030 that defines the seat 1022 such the needle slot 938 and the shaft slot 928 [behind the needle 930' and the projection 1030 that forms the seat 1022] are in line with and adjacent the seat slot 1028.
- the shaft slot 928 and the needle slot 938 are visible in Figs 1D and 1E , discussed earlier.
- the interlock 2050 remains in its initial locked position 1050A which ensures that the base 1020 remains coupled to the housing 1010' as shown in Figs. 9A[i] , 9A[ii] .
- the interlock arm 2056 is positioned axially adjacent and distal to the base 2020. The interlock arm prevents the movement of the base 2020 relative to the housing 2010'.
- the rocker bar 2055 moves the interlock tab 2054 adjacent the base wall 2054' to be positioned out of way of the interlock 2050.
- the interlock 2050 is then moved from its locked position 2050A to its unlocked position 2050B to disengage the base 2020 from the housing 1010' [which defines a suture transferring component 1011 as discussed previously herein].
- the base 2020 moves distally and presses against the push sleeve hub 2012 that moves distally within the sleeve cavity 2012'.
- the push sleeve hub 2012 is biased towards the base 2020 via a spring mechanism [that comprises two springs 2013], it functions to push the push rod hub 2057 upon translation of the suture transferring component 2011 with respect to the base 2020.
- the push rod hub 2057 translates proximally within push rod cavity 2057' ( Figs.
- the knot slider 2030 is moveable with base 2020 the knot slider 2030 is moveable distally along the knot slider recess 2018 within the housing sleeve 2011' upon distal movement of the base 2020 within the housing sleeve 2011'.
- the wall of the housing sleeve 1011' adjacent the tapered inner wall 2019 [ Fig. 8B ] of the knot slider recess 2018 functions as a stop to prevent further distal movement of the knot slider 2030 to disengage snap arms 2042 of the base 2020 from the snap grooves of the knot slider 2030, as shown in Fig.9F .
- the knot slider release interlock 2033 is disengaged releasing the knot slider 2030.
- the housing 1010' additionally provides for loading a partially pre-tied knot on the suturing instrument 900.
- the suture is contained within tubing [for example inside a polytetrafluoroethylene (PTFE) tube] mounted on the inside the knot slider 2030 [ Fig. 11D ], the cartridge additionally provides for loading or mounting the suture limbs within the knot slider 2030 on the suturing instrument 900 along with the partially pre-tied knot.
- PTFE polytetrafluoroethylene
- the cartridge 2000 may then be removed and may be pulled proximally.
- the cartridge 2000 is loaded onto the suturing instrument 900 and removed thereafter using a pumping action.
- the relative movement of the suturing instrument with respect to the cartridge 2000 is in a proximal direction.
- the suturing instrument 900 is pulled proximally the knot slider 2030 remains mounted thereon and is removed with the suturing instrument 900 (as shown in Fig. 10A ).
- the distal head 920 interacts with the bevel face 1043' of the rocker 1041 ( Fig. 10B ). This enables the rocker 1041 to move out from the tissue receiving gap 942 allowing the suturing instrument 900 to be removed, without hindrance as shown in Fig. 10C .
- the knot slider arm 2034 is slidable along the instrument window or groove 965 in said inner position 2034A.
- the knot slider arm 2034 may remain in its initial position 2034A as it is slid proximally along the instrument proximal portion or shaft 910, for example to be attached with a handle portion 960 of the instrument 900 [shown in Fig. 11A ].
- the instrument 900 may be used thereafter to deploy the pre-tied knot 502.
- the knot slider 2030 disengages from the handle portion of the suturing instrument and slides distally along the shaft proximal portion of the suturing instrument 900. As shown in Fig.
- examples additionally provide a cartridge 2000 that provides a means to load suture into a suture passing instrument 900 of the type as described herein having an instrument proximal portion 910 and an instrument distal end 920 defining a tissue receiving gap 942 there-between.
- the current embodiment additionally facilitates automatic alignment of suture 500 (for example end 504 of the suture 500) by allowing the rocker 1041 to pivot into the tissue receiving gap upon engagement with the instrument distal end 920 as it is being advanced into the cartridge 1000.
- cartridge 2000 provides a suture transferring component 2011 to transfer suture into the suture passing member and additionally provides a knot slider 2030 to mount a pre-tied knot 502 onto the suturing instrument 900.
- a suture cartridge is provided that exerts a force on the end of the suture to load it into the surgical suturing instrument or the suture Passer. All mechanical events achieved by the suture cartridge device are obtained in a single "pump' action performed by the user and in some examples may not require actuation of the suture passer (suturing instrument) trigger. ā In some such examples the single "pump' action maybe likened to that of a shotgun loading action.
- a suture cartridge uses a pushing force on the end of the suture to load it into the suture passer as outlined in example 4 herein above.
- the cartridge applies a direct pushing force to the suture to load it onto the suture passer.
- the cartridge comprises a push rod which is a part of the cartridge independent from the seat and suture passer. It is a piece that exists inside the seat and upon actuation presses against the end of the suture to push it forwards in the seat.
- the mechanical events to insert the suture occur in the following ways: (i) to apply the force to the end of the suture a flexible, moveable push rod exists in an S-shaped lumen that exists in the seat.
- the push rod has a tip that contacts the suture.
- the suture passer is fixed with respect to the Suture, such that when the applied pushing force is exerted onto the suture, the suture passer stays still and the suture moves towards and into the suture passer.
- the seat is also fixed with respect to the push rod and suture, such that when the applied pushing force is exerted onto the suture, the seat stays still and the suture moves away from and out of the seat.
- the push method can be used when a high loading force is required.
- the cartridge mechanism comprises a push rod that is a piece that can move independently from the cartridge base, seat and suture passer and it is a piece that exists inside the seat and upon actuation presses against the end of the suture to push it forwards in the Seat.
- the push insertion mechanism is configured such that the push rod pushes the suture once the seat has fully aligned the Suture with the suture passer. This may be done by way of a series of interlocks that prevent the push rod from moving relative to the seat until the full alignment step has occurred (i.e. prevents the suture from being pushed before it is fully aligned).
- Push Rod Interlock to prevent the push rod from moving before the seat is aligned with the needle.
- Push Spring in some examples the push rod is actuated with a spring (as outlined above in example 4) to ensure that a given amount of force was being exerted on the suture for a given displacement of the push rod. This force would be calibrated to be much greater than the maximum theoretical/empirically derived force required to successfully load the Suture. Once this force was achieved, a certain displacement would also be achieved and the interlock would unlock the Suture.
- the cartridge is configured for containing a pre-tied knot on a knot slider which also houses the suture strands.
- the Knot Slider [for e.g. 2030 as described above) automatically detaches from the cartridge Base and remains on the suture passer after the suture cartridge is actuated.
- the knot slider functions to release the suture knot to the surgical site once the suture passer is used.
- interlock may be provided.
- Knot slider release interlock (for example knot slider release interlock 2033 as described above) which prevents the knot slider form releasing until the suture has been loaded into the needle.
- the cartridge in some examples stores the suture limbs within the Knot Slider inside a (polytetrafluoroethylene) PTFE tube. Furthermore, as outlined in example 4, the cartridge comprises knot slider retention features on shaft. In some examples the cartridge has a Knot Slider that contains a tail hook that retains the knot slider on the suture passer shaft at the end of the procedure. As outlined previously, the tail hook is enclosed within the knot slider and once the knot slider slides to the end of the shaft, the tail hook slides out of the knot slider and hooks onto the shaft.
- a cartridge for loading suture at the point-of-use onto a surgical suturing instrument such as a suture passing instrument or suture passer, where the suturing instrument includes a suture passing member onto/into which the suture is to be loaded, and where the application requires/benefits from a pre-tied knot.
- a surgical suturing instrument such as a suture passing instrument or suture passer
- a suture loading cartridge is provided with a feature for securing a pre-tied knot with the ability to deploy the pre-tied knot onto the suture passer (for example by passing the suturing instrument through a chamber of the cartridge that has the knot tied about it), as well as a second feature for aligning a suture end with the suture passing member of the suture passer to facilitate loading of the suture onto/into the suture passing member.
- the second feature for aligning the suture may be movable with respect to the first feature (so that the suture passer can be inserted into the cartridge through the pre-tied knot after which a suture end loaded into the cartridge can be brought into alignment with the suture passing member).
- examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge defining a path for insertion thereto and withdrawal therefrom of the suturing instrument, the cartridge comprising:a seat for releasably holding a portion of a suture; and a translation mechanism for moving the seat out of a path of a suturing instrument inserted into the cartridge to allow for withdrawal of the suturing instrument from the cartridge.
- examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture; and an alignment feature for facilitating alignment of the seat with a suturing instrument to permit transfer of the suture portion from the seat onto the suturing instrument.
- examples provide A cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for holding a portion of the suture; and an instrument retention mechanism configured to allow advancement of a suturing instrument into the cartridge and to prevent premature retraction therefrom.
- examples comprise a cartridge for loading a suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture to enable transfer of the suture onto the suturing instrument; and an indicator for indicating transfer of the suture portion onto the suturing instrument.
- a cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for holding a portion of a suture; and an obstructing feature having a closed configuration and an open configuration, the obstructing feature being configured to be initially in the closed configuration for preventing advancement of an inverted suturing instrument into the cartridge, and to be moveable into the open configuration upon insertion of the suturing instrument into the cartridge in a nominal orientation.
- examples provide a cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of the suture; an alignment feature for aligning the seat with a portion of the suturing instrument; a suture insertion mechanism that is actuatable to insert the suture portion from the seat onto the suturing instrument; and a delay interlock to prevent actuation of the suture insertion mechanism prior to alignment of the seat with the portion of the suturing instrument.
- examples provide a cartridge for loading a pre-tied knot onto a suturing instrument, the cartridge comprising: a cartridge housing; a knot slider for carrying a pre-tied knot thereabout; and a knot slider release mechanism for detachably coupling the knot slider to the cartridge housing.
- examples provide a cartridge for loading suture onto a suturing instrument comprising a suture passing member, the cartridge comprising a seat for holding an end of the suture, the seat being structured and configured to allow a suture passing member to be advanced over the suture end to capture the suture end.
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Description
- The disclosure relates to a suturing kit.
- Documents
US 2011/082471 andWO 02/30294 claim 1. The invention is disclosed in the appended set of claims and especially disclosed infigures 13A-13J and Ā§134-146 and Ā§193. Various examples of a cartridge are disclosed, for loading a suture onto a suturing instrument and, in some examples, for loading a pre-tied knot formed from the suture onto the suturing instrument. The suturing instrument is typically of the type having a suture passing member defining a suture receiving passage therein. The cartridge may be operable to load the suture and/or the knot onto the suturing instrument at a point of use. In some examples, the cartridge defines a path for insertion thereto and withdrawal therefrom of the suturing instrument. The cartridge further comprises a seat for releasably holding a portion of a suture and a mechanism for transferring the suture from seat to the suturing instrument, various features of which are described herein. - In one aspect, examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge defining a path for insertion thereto and withdrawal therefrom of the suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture; and a translation mechanism for moving the seat out of a path of a suturing instrument inserted into the cartridge to allow for withdrawal of the suturing instrument from the cartridge.
- In another aspect, examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture; and an alignment feature for facilitating alignment of the seat with a suturing instrument to permit transfer of the suture portion from the seat onto the suturing instrument.
- In still an additional aspect, examples provide a cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for holding a portion of the suture; and an instrument retention mechanism configured to allow advancement of a suturing instrument into the cartridge and to prevent premature retraction therefrom.
- In further examples a cartridge for loading a suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture to enable transfer of the suture onto the suturing instrument; and an indicator for indicating transfer of the suture portion onto the suturing instrument.
- In still an additional example, a cartridge is provided for loading suture onto a suturing instrument, the cartridge comprising: a seat for holding a portion of a suture; and an obstructing feature having a closed configuration and an open configuration, the obstructing feature being configured to be initially in the closed configuration for preventing advancement of an inverted suturing instrument into the cartridge, and to be moveable into the open configuration upon insertion of the suturing instrument into the cartridge in a nominal orientation.
- In still another broad aspect, examples of a cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of the suture; an alignment feature for aligning the seat with a portion of the suturing instrument; a suture insertion mechanism that is actuatable to insert the suture portion from the seat onto the suturing instrument; and a delay interlock to prevent actuation of the suture insertion mechanism prior to alignment of the seat with the portion of the suturing instrument.
- In still another broad aspect, examples provide a cartridge for loading a pre-tied knot onto a suturing instrument, the cartridge comprising: a cartridge housing; a knot slider for carrying a pre-tied knot thereabout; and a knot slider release mechanism for detachably coupling the knot slider to the cartridge housing.
- In an additional broad aspect, examples of the present invention provide a cartridge for a cartridge for loading suture onto a suturing instrument comprising a suture passing member, the cartridge comprising a seat for holding an end of the suture, the seat being structured and configured to allow a suture passing member to be advanced over the suture end to capture the suture end.
- Furthermore, as a broad aspect of the present invention, embodiments of a kit are provided, the kit generally including at least one cartridge as described hereinbelow, along with at least one suturing instrument, the cartridge being operable in cooperation with the suturing instrument to load suture from the cartridge onto the instrument.
- In order that the invention may be readily understood, embodiments of the invention are illustrated by way of examples in the accompanying drawings, in which:
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Fig. 1A illustrates a left side perspective view of a cartridge; -
Fig. 1B illustrates a right side view of a cartridge; -
Fig. 1C illustrates a left side view of a portion of a surgical suturing instrument for use with a cartridge in accordance with an embodiment of the present invention; -
Fig. 1D illustrates a right side view of a portion of surgical suturing instrument for use with a cartridge in accordance with an embodiment of the present invention; -
Fig. 1E illustrates a cross-sectional view of a portion of the surgical suturing for use with a cartridge in accordance with an embodiment of the present invention; -
Fig. 1F illustrates a left side view of a cartridge mounted onto a surgical suturing instrument in accordance with an embodiment of the present invention; -
Fig. 2A illustrates a cross-sectional view of a cartridge; -
Fig. 2B illustrates a cross-sectional view of a cartridge with a surgical suturing instrument partially advanced therein, in accordance with an embodiment of the present invention; -
Fig. 2C illustrates a cross-sectional view of a cartridge with a surgical suturing instrument advanced therein, in accordance with an embodiment of the present invention; -
Figs. 3A-3O illustrate views of a cartridge in accordance with an alternate example; -
Figs 4A-4D illustrate views of a cartridge and a method of using the same; -
Figs 5A-5C illustrate views of an interlock mechanism of a cartridge in accordance with an example; -
Figs 6A-6B illustrate views of an interlock mechanism of a cartridge; -
Figs. 7A-7F illustrate views of a suture lock mechanism of a cartridge; -
Figs 8A-8H(ii) illustrate views of a cartridge; -
Figs. 9A(i)-9F illustrate views of a cartridge and a method of using the same; -
Figs 10A- 10D(ii) illustrate views of a cartridge and a method of using the same; -
Figs. 11A-11D illustrate views of a knot slider of a cartridge a method of using the same; -
Figs. 12A-12F illustrate a side loading alignment mechanism of a cartridge and a method of using the same; -
Figs. 13A-13L illustrate views of a cartridge; -
Figs. 14A-14G illustrate views of a rocker; -
Figs. 15A(i)-15C(iii) illustrate a cartridge comprising an instrument retention mechanism; -
Figs. 16A-16D illustrate a cartridge comprising an instrument retention mechanism; -
Figs. 17A-17C(ii) illustrate a still further alternative for an instrument retention mechanism; -
Figs. 18Ai)-18F illustrate a cartridge and method of use thereof; -
Figs. 19A-19C illustrate an alternate embodiment of a cartridge knot slider comprising a feature to prevent upside-down (reverse-oriented) insertion of the suturing instrument; -
Figs. 20A-20B illustrate an alternate example of an interlock for preventing upside-down (reverse-oriented) insertion of the suturing instrument; -
Figs. 21Ai)-21Bii) illustrate an alternate example of an interlock for preventing upside-down (reverse-oriented) insertion of the suturing instrument; -
Figs. 21C-21E illustrate alternate examples of an interlock for preventing upside-down (reverse-oriented) insertion of the suturing instrument; -
Figs. 22A-22E illustrate various views of a knot slider comprising an attachment mechanism for slidably engaging with the suturing instrument; -
Fig. 22F illustrates a view of a knot slider comprising a feature to facilitate sliding of the knot slider on the suturing instrument; -
Figs. 23A-23G illustrate various views of an alternate example of a cartridge for facilitating capture of a suture portion by a suture passing member; and -
Figs. 24Ai)-24Cii) illustrate various alternative of a cartridge. - In certain medical interventional procedures, a suturing instrument may be used by physicians to pass suture through a region of tissue having a cut or a defect in order to approximate the tissue to repair the defect. In some such procedures, there may be a need to load suture onto the surgical suturing instrument at the point of use. However, it may be difficult to load the suture using conventional loading mechanisms as they may require the user to perform several steps, may require user dexterity, concentration and a specific order of operation which if done out of order could result in a failure of the device and may be time consuming. Thus, there is a need in the art to provide a cartridge for loading suture onto a suturing instrument at the point of use that provides ease of use and which allows the suture to be loaded in an efficient manner.
- The present inventors have discovered, and reduced to practice, several embodiments of a novel apparatus and method that facilitates loading of suture onto a suturing instrument at the point of use. Examples of a cartridge is provided that permits loading of a suture onto a suturing instrument upon axial or linear movement of the suturing instrument at least partially through the cartridge. The cartridge may additionally comprise one or more features that facilitate alignment and transferring of the suture onto the instrument.
- More specifically, some examples provide a suture cartridge that is usable for loading suture onto a medical device such as a surgical suturing instrument at the point of use in a situation where suture is to be supplied separate from the device. In some examples a cartridge is provided that allows the physician to load the suture onto a surgical suturing instrument prior to a surgical procedure using an axial or front end loading mechanism. The cartridge defines a seat for holding a portion of the suture and defines an opening extending longitudinally through at least a portion of the cartridge, which allows a portion of the surgical suturing instrument to be received axially there-through for aligning a portion of the suture held therein with the surgical suturing instrument. This allows direct transfer of the portion of the suture held within the seat from the cartridge onto the surgical suturing instrument, allowing it to be independently transferred to enable the surgical suturing instrument to suture therewith.
- In some examples, the cartridge may additionally comprise one or more features that facilitate transferring or loading the suture onto the device.
- In some examples, the cartridge additionally provides one or more of: a means to mount a pre-tied knot onto the surgical instrument, a restraint to secure a position of the suturing instrument upon insertion into the cartridge, and an alignment feature to align the suture with the suturing instrument, such as a moveable seat. In some such examples, a cartridge is provided that is usable with a suturing instrument that defines a tissue receiving gap, where the cartridge is configured to position the seat within the tissue receiving gap to facilitate alignment of the portion of the suture held within the seat with a suture passing member of the suturing instrument.
- Certain examples thereby provide a suture cartridge for loading suture onto a suturing instrument, for example at a point of use, by efficiently aligning the suture with the suturing instrument. In some examples, the cartridge additionally provides one or more of a means to load a pre-tied knot onto a suturing instrument and a means for transferring the suture onto the suturing instrument.
- Furthermore, several novel examples of methods for loading a suture onto a suturing instrument are described hereinbelow. In addition, methods of suturing tissue of an intervertebral disc including a cartridge for loading the suture onto a suturing instrument, are described as well.
- With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of certain embodiments of the present invention only. Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of the components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments or of being practiced or carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein is for the purpose of description and should not be regarded as limiting.
- In accordance with an example a suture carrying cartridge is provided for loading a surgical suturing instrument such as a suture passer at the point of use (where the suturing instrument requires a pre-tied knot and comprises a suture passing member, and where loading involves loading the suture onto the suture passing member and loading the pre-tied knot onto the surgical suturing instrument). The suture carrying cartridge (having a pre-tied knot secured thereto) is coupled to the suture passer and allows coupling of the suture to the suture passing member by allowing the suture to be moved so that it is aligned with the suture passing member.
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Fig. 1A further illustrates acartridge 100 in accordance with an example. Thecartridge 100 is provided for loading a length ofsuture 500 onto a surgical suturing instrument including loading apre-tied knot 502 comprising suture loops (which in some examples is formed from and/or attached to the suture 500) onto the suturing instrument. In exemplary embodiment shown, thesuture 500 may define an end portion 504 (of the suture (or suture end) 504, such as a knot 504'), for loading onto thesurgical suturing instrument 900. As shown inFig. 1B , thesuture 500 emanating from thepre-tied knot 502 terminates in two strands of suture: aservice loop 501 terminating intug loop 507 that is connected to thesuture end 504, and alocker 503. In some examples the surgical suturing instrument is of the type defining a suture passing member defining a suture receiving passage therein for receiving theend portion 504 of thesuture 500 from thecartridge 100. - In one example as illustrated in
Figs 1C and1D the surgical suturing Instrument or suturinginstrument 900 is of the type having an instrument proximal portion (or shaft) 910 and an instrumentdistal portion 920 coupled thereto via aneck portion 940 and defining atissue receiving gap 942 there-between. The instrumentdistal portion 920 may alternatively be referred to as the distal end ordistal tip 920. As shown in the cross-sectional view of Fig. IE, thesuturing instrument 900 comprises asuture passing member 930 such as a hollow needle 930' housed within the instrumentproximal portion 910, thesuture passing member 930 defining asuture receiving passage 932 for receiving theend portion 504 of the suture. In some examples, thesuture passing member 930 is reciprocally movable for example, between the deviceproximal portion 910 and the devicedistal portion 920. In some examples movement of the suture passing member 930may assist in transferring thesuture end portion 504 from thecartridge 100 to thesuturing instrument 900. In a particular example thesuturing instrument 900 is of the type shown and described in the PCT application:PCT/IB2012/054204 - Referring again to the exemple shown in
Fig. 1A , acartridge 100 is shown for loadingsuture 500 onto thesurgical suturing instrument 900. Thecartridge 100 comprises a housing 10' defining achamber 10 for receiving thesurgical suturing instrument 900. The cartridge further comprises a base 120 coupled to thechamber 10. - In the specific example shown in
Fig. 1A , thechamber 10 comprises a means for securing or mounting thepre-tied knot 502 about thechamber 10. In the illustrated embodiment, the means for securing thepre-tied knot 502 comprises amount 12 for holding thepre-tied knot 502 about thechamber 10. More specifically, themount 12 may form a part of the housing 10'. Additionally, thechamber 10 defines a channel to allow a portion of thesuturing instrument 900 to be received through thepre-tied knot 502 to enable thepre-tied knot 502 to be deployed thereon. - In the exemplary embodiment shown in
Fig. 1A , thebase 120 defines aseat 122 for releasably holding a portion of asuture 500, such as anend 504 of thesuture 500. In the specific example shown, theseat 122 defines a seat channel (recess or passage) 124 for retaining thesuture end 504. More specifically, thecartridge 100 specifies aseat 122 for 'directly holding' theend 504 of thesuture 500 such thesuture 500 by itself is held directly by theseat 122. - In accordance with an example the
cartridge 100 is structured to allow theseat 122 to be brought into alignment with and in some examples adjacent thesuture receiving passage 932 of thesuture passing member 930. In some examples, as will be discussed herein below with respect Fig. IF, theseat 122 is moveable (along with the base 120) relative to thechamber 10 and housing 10' to bring thesuture end 504 into alignment with thesuture receiving passage 932. - In some examples as shown in
Fig. 1A , thecartridge 100 includes an alignment feature that restrains or fixes/locks the position of thesuturing instrument 900 relative to the cartridge to help align theseat 122 withsuture receiving passage 932 of the of thesuture passing member 930 such as a needle 930'. More specifically, thecartridge base 120 comprises a restraint 25 (means for restraining) for positioning a portion of thesuturing instrument 900 received through thechamber 10 relative to theseat 122 for aligning theseat 122 with asuture receiving passage 932 of thesuture passing member 930. In some examples, the restraint may function as a means for locking or snapping thecartridge 100 onto the suturing instrument, such as a locking feature. In the embodiment illustrated inFig. 1A , therestraint 25 comprises a recess that functions as alocking recess 125 for receiving a portion of thesurgical suturing instrument 900. As shown in Fig. IF, thelocking recess 125 receives thesuturing instrument 900 and allows thebase 120 of thecartridge 100 to be latched onto thesuturing instrument 900. In other words, thelocking recess 125 within thebase 120 receives a portion of the surgical suturing instrument 900 (neck portion 940 and sections of the proximal anddistal portions 910, 920) such that the base 120 press-fits around the portion of thesuturing instrument 900, to lock the position of thesurgical suturing instrument 900 relative to thebase 120. - As shown in
Fig. 1A , thecartridge 100 additionally comprises an alignment feature in the form of analignment recess 130 located adjacent theseat 122. In a specific example, as shown in Fig. IF, thealignment recess 130 is sized to allow thesuture passing member 930 to be advanced therein to allow thesuture receiving passage 932 to be aligned with theseat 122. As shown in Fig. IF, thealignment recess 130 additionally comprises abevel face 134 that matches thebevel face 934 of the needle 930' to further assist in aligning the needle 930' with theseat 122. Thus in the exemplary embodiment, thealignment recess 130 receives a portion of thesuture passing member 930 such as needle 930' when it is advanced distally to allow thesuture receiving passage 932 to be placed in line with thesuture end 504 held within theseat 122. This permitssuture 500 to be loaded onto thesuturing instrument 900, for example by allowing the tug loop 507 (that is connected to theend portion 504 of the suture 500) to be pulled to transfer thesuture end 504 from thecartridge 100 into thesuture receiving passage 932. Thealignment recess 130 allows theseat 122 to be brought adjacent and in communication with thesuture receiving passage 932 to allow thesuture end 504 to be transferred into the lumen of thesuture passing member 930. - The cartridge may additionally comprise features to assist in routing of the
suture 500 to facilitate manipulation of thesuture 500 in order to transfer thesuture 500 from thecartridge 100 to thesurgical suturing instrument 900. With reference now toFigs. 1B and IE, in some examples thebase 120 of thecartridge 100 further defines a base channel orbase slot 128 in communication with theseat 122 for routing thesuture 500 to facilitate manipulation of thesuture 500 in order to load thesuture 500 onto/within thesuture passing member 930. In some examples, once thecartridge 100 is loaded onto thesuturing instrument 900, thebase slot 128 may be aligned with alongitudinal opening 928 within the suturing instrument 900 (for example, within the instrument proximal portion 910). In some examples, thesuture passing member 930 may also comprise aslit 938 that can line up with thebase slot 128 so that it is in communication with thebase slot 128. This facilitates loading of thesuture 500 into thesuture receiving passage 932 by allowing room forsuture 500 to exit thecartridge 100, so that it may be manipulated, for example by tugging on thesuture 500 to allow it to be transferred from theseat 122 to within thesuture passing member 930. - In some examples, the
cartridge 100 may comprise a base 120 that is formed integrally with thechamber 10 or housing 10'. In other examples, thebase 120 may be detachably coupled to the housing 10' via adetachable coupling 50, as shown inFig. 1A . This may allow the base 120 to be decoupled to from the housing 10' aftersuture end 504 is loaded into a suturing instrument using thecartridge 100. The housing 10' may then be advanced or slid proximally to position the housing 10' andpre-tied knot 502 thereon along the instrument proximal portion, to permit deployment of thepre-tied knot 502 after the suturing instrument is used to apply suture to a region of tissue (such as an inter-vertebral disc) to help secure thesuture 500 within the region of tissue. - In some such examples, with reference now to
Figs. 1A and1B , thebase 120 is indirectly coupled to the housing 10' through aflexible coupling 150 such as a flexible tube ortether 152. In some examples, a first end of theflexible tube 152 may be affixed permanently to one of thebase 120 and the housing 10', whereas the a second end of theflexible tube 152 may be removably attached to the other of thebase 120 and the housing 10'. In the example shown, one end of theflexible tube 152 is permanently secured to thebase 120 within thebase slot 128 and the second end of theflexible tube 152 is received within agroove 16 within the housing 10' to be removably attached thereto. Alternatively, both ends of theflexible tube 152 could be permanently affixed to each of thebase 120 and the housing 10' and theflexible tube 152 may be designed with break lines to allow separation of theflexible tube 152 into two parts under application of force, allowing detachment of the base 120 from the housing 10'. In another example, theflexible coupling 150 may comprise a flexible or soft hinge. Alternatively, thebase 120 may be directly coupled to the housing 10'. - In some examples, the
cartridge 100 may additionally comprise a means to store the length ofsuture 500 such assuture storage 60, shown inFig. 1B . Thesuture storage 60 may comprise one ormore spools 160 held within thecartridge 100 to store the length ofsuture 500. More specifically, the one ormore spools 160 may be held within the housing 10' to store theservice loop 501 and thelocker 503 of thesuture 500. The one ormore spools 160 may help prevent entanglement of thesuture 500 during loading of thesuturing instrument 900 and/or during use of thesuturing instrument 900. Alternatively, thesuture 500 may be held within suture payout tubes.. - Referring again to
Fig. 1B , in some examples thecartridge 100 comprises asuture retaining component 65 such as asuture retaining pin 165 for retaining a portion of thesuture 500 to allow thetug loop 507 of thesuture 500 to be pulled (to transfer thesuture end 504 within thesuture receiving passage 932 of the suture passing member 930) while minimizing or preventing force from being applied to theservice loop 501. This may help prevent theservice loop 501 from being pulled out prematurely from thesuture storage 60. In the illustrated embodiment, thesuture retention pin 165 is releasable which allows the housing 10' (and thus chamber 10) to be advanced independently from thebase 120 proximally along theproximal portion 910 of thesurgical suturing instrument 900 in order to place the housing 10' in a position for deployment of thepre-tied knot 502 carried thereon. - In an alternate example, as shown in
Figs. 2A-2C , acartridge 400 is disclosed. Similar to cartridge 300,cartridge 400 provides aseat 422 that is moveable relative to the chamber 10 (housing 10'). Additionally,cartridge 400 incorporates aseat 422 that is automatically moveable. - With reference now to
Fig. 2A , acartridge 400 is disclosed comprising acartridge base 420 that is coupled to a housing, for example a housing 10' of the type discussed previously herein above. In one example, thebase 420 may be detachably coupled to the housing 10' (chamber 10).Base 420 comprises amagazine 421 which defines theseat 422 for releasably holding or retaining thesuture end 504. More specifically, themagazine 421 comprises aprojection 430 which defines theseat 422. In a specific example theseat 422 comprises aseat channel 424 and thesuture end 504 is press-fit within the seat channel. - In the embodiment shown in
Figs. 2A-2C , thecartridge 400 comprises an alignment feature in the form of arestraint 25 comprising an instrument receiving recess or locking recess 425' that allows thesuturing instrument 900 to be positioned within thebase 420 to allow theseat 422 to be aligned with thesuture receiving passage 932. Additionally the alignment comprises amoveable seat 422. Themagazine 421 is mounted onto aspring 426 forming a spring biased interlock 421' which is automatically moveable upon advancement of thesurgical suturing instrument 900 within an instrument receiving recess 425' of thebase 420. Movement of the interlock 421' translates into a movement of theprojection 430 defining theseat 422. Thus theseat 422 is moveable upon advancement of thesuturing instrument 900 to bring the suture into alignment with thesuture receiving passage 932. Thus in some examples, themagazine 421 comprises a spring biased translation mechanism. - More specifically, referring now to
Figs. 4B , the spring biased interlock 421' is shown in itsinitial position 421A. As shown inFig. 2C , the interlock 421' is moveable from its first orinitial position 421A into its second position 421B upon advancement of thesuturing instrument 900 within the instrument receiving recess 425'. Movement or depression of the interlock 421' into its second position 421B allows theseat 422 to be brought into alignment with thesuture passing member 930 and thesuture receiving passage 932. More specifically, the interlock 421' comprises a ramp 423 (shown inFigs. 2A, 2B ) that is engaged by thedistal tip 920 of theinstrument 900 as thesuturing instrument 900 is advanced to automatically move the interlock 421'. Forexample ramp 423 is engaged by a tapered surface of thedistal tip 920. As a result seat 422 (defined by projection 430) is automatically moveable and travels downwards into thetissue receiving gap 942 to bring the seat 422 (and thus thesuture end 504 it retains) into alignment with thesuture receiving passage 932 of thesurgical suturing instrument 900. In other words, the (magazine 421) and thusseat 422 is automatically moveable upon relative movement between thecartridge base 420 and thesurgical suturing instrument 900. - In some examples, an additional alignment feature is provided to further aid in aligning the
seat 422 with thesuture receiving passage 932. As mention previously,cartridge base 420 comprises aprojection 430 that defines theseat 422. Theprojection 430 extends into the instrument receiving recess 425' and defines an alignment feature. Theprojection 430 is capable of abutting against/mating with thesuture passing member 930 such as needle 930' when brought into engagement therewith. In the present embodiment illustrated inFig. 2C , as thesurgical suturing instrument 900 is advanced, themagazine 421 moves downwards into the tissue receiving gap.Magazine 421 ,and thusprojection 430 and theseat 422 it defines, all move proximally with respect to thesuturing instrument 900, so that theprojection 430 abuts against the needle 930' to align theseat 422 with thesuture receiving passage 932. More specifically, theprojection 930 abuts against the needle 930' to co-operatively engage with and align the needle 930' to bring theseat 422 into alignment with thesuture receiving passage 932. Theseat 422 is brought into communication with thesuture receiving passage 932. In the specific example shown inFigs. 2B-2C , theprojection 430 defines a bevel face 434 for engaging with abevel face 934 of the needle 930' for docking the needle 930' to align the needle 930' with the seat 222 to permit transfer of thesuture end 504 from the seat 222 into thesuture receiving passage 932 of the needle 930' for example by pulling on thetug loop 507. Alternatively, in some examples, thesuture end 504 may be transferred automatically from theseat 422 into thesuture receiving passage 932 for example using a plunger. - In one particular embodiment, the
cartridge 400 may comprise a mechanism to permit automatic decoupling of the cartridge base from thesuturing instrument 900 and/or the housing 10'. In the illustrated embodiment, once thesuturing instrument 900 is withdrawn from thecartridge base 420, the spring biased interlock 421' is capable of automatically returning from its second position 421B (shown inFig. 2C ) to itsoriginal position 421A (shown inFig. 2A ) to permit de-coupling of the base 420 from thesuturing instrument 900 and/or housing 10' (chamber 10). - In an alternate example, as shown in
Figs. 3A-3I , acartridge 1000 is disclosed for loading suture onto a surgical suturing instrument, for example asuturing instrument 900 as discussed previously herein above with reference toFig. 1E . Thecartridge 1000 carries suture therein and functions to align the suture with thesuturing instrument 900 upon insertion and axial advancement of thesuturing instrument 900 within thecartridge 1000, in order to allow transfer of suture onto thesurgical suturing instrument 900. In some such examples, thecartridge 1000 additionally functions to transfer the suture onto thesuturing instrument 900. - In the specific example shown in
Figs. 3A and3B , acartridge 1000 is provided that is functional to carry suture for loading onto asurgical suturing instrument 900. The cartridge comprises a housing 1010' that defines a chamber for axially receiving thesurgical suturing instrument 900. Additionally, thechamber 1010 includes a recess or channel that is a part of thechamber 1010 that receives thesuturing instrument 900. As such in some examples, as discussed herein the channel may be referred to as a channel or a recess. In the particular example discussed herein thechamber 1010 defines a channel for receiving the suturing instrument. The cartridge further comprises a base 1020 that is detachably coupled to the housing 1010' that defines a seat for releasably holding the suture therein and enables alignment of the suture with thesuture passing member 930 of thesuturing instrument 900. The housing 1010' additionally comprises a means to secure a portion of the suture thereto and is detachable from thebase 1020 to function as a suture transferring component to transfer suture from the cartridge onto thesuturing instrument 900. Thus, in some examples, as shown inFig. 3B thebase 1020 and the housing 1010' comprise separate components of thecartridge 1000 that are coupled to one another to assist in loading suture and may be detachable therefrom to assist in transferring suture. In other examples, the housing 1010' may be integrally formed with thebase 1020. In some examples thebase 1020 may be formed from twohalves base 1020 collectively provide alignment features to assist in alignment of the suture upon loading of thecartridge 1000 onto thesuturing instrument 900 to facilitate transfer of suture from thecartridge 1000 onto thesuturing instrument 900 using the suture transferring component. The detailed mechanism and operation of thebase 1020 and the housing 1010' in aligning and transferring the suture are described further herein below. - With reference now to
Fig. 3C , in some examples the housing 1010' of the cartridge defines achamber 1010 that comprises achannel 1014 for receiving the suturing instrument there-through. In some examples, thechannel 1014 comprises aproximal opening 1016 that narrows towards the interior of the cartridge housing 1010' as defined by a beveled interior edge 1016'. The beveled interior edge 1016' functions as a lead in to guide thesuturing instrument 900 into thechannel 1014. Thechannel 1014 extends longitudinally through the housing 1010' and is in communication with arecess 1025 that defines an instrument receiving recess or locking recess] formed within thebase 1020. In some examples thechannel 1014 may be formed continuously with therecess 1025 within thecartridge base 1020. Thechannel 1014 defines an opening through which thesuturing instrument 900 may be advanced though the housing 1010' into thebase 1020. Thechannel 1014 and therecess 1025 each function as arestraint 25 to constrain or restrict the lateral and transverse movement of thesuturing instrument 900 within thecartridge 1000 while allowing thesuturing instrument 900 to be advanced linearly or axially therein in sliding engagement to maintain the position of thesuturing instrument 900 along the longitudinal axis as it is advanced. As such therestraint 25 constraints or limits the movement of thesuturing instrument 900 in the transverse and lateral directions as well along a longitudinal path defined thereby. Thus therestraint 25 facilitates alignment of thesuturing instrument 900 with a portion of thesuture 500 that is held within aseat 1022 defined by the base 10207 More specifically, thechannel 1014 and therecess 1025 allow thesuturing instrument 900 to be advanced therein in sliding engagement therein and additionally function to restrain thesuturing instrument 900 in a linear path as it is advanced along thecartridge 1000 to allow theseat 1022 to be aligned with thesuture receiving passage 932 of the suture passing member. - Therefore, the
cartridge 1000 comprises an alignment feature in the form of arestraint 25 that comprises an instrument receiving recess defined bychannel 1014 andrecess 1025, which allow thesuturing instrument 900 to be positioned within thebase 1020 to allow theseat 1022 holding a portion of the suture to be aligned with thesuture passing member 930 of thesuturing instrument 900. - Furthermore, in some examples as shown in
Figs. 3C ,3D and 3E , therecess 1025 within the base is formed from two grooves, aninstrument receiving groove 1025a defining an instrument receiving recess and asuture receiving groove 1025b defining a suture receiving recess, as shown inFig. 3F . The instrument andsuture receiving grooves halves Fig. 3B ). With reference again toFig. 3D , theinstrument receiving groove 1025a provides a track which functions as arestraint 25 to allow thesuturing instrument 900 to be advanced therein, whereassuture groove 1025b provides a track to guide the portion of the suture held within the seat into thesuture passing member 930 of thesuturing instrument 900 by maintaining/routing thesuture 500 therein such that it is adjacent and in line with the shaft orproximal portion 910 of thesuturing instrument 900 that is receivable within theinstrument receiving groove 1025a as further illustrated inFig. 3E . More specifically, thesuture receiving groove 1025b allows the suture to be routed such that when the suturing instrument is received within theinstrument receiving recess 1025b, thesuture 500 is held adjacent thegroove 928 within the shaft or the instrumentproximal portion 910 as well groove 938 withinsuture passing member 930 such as needle 930' (shown in Fig. IE). Furthermore, thegroove 1025b provides room for routing the suture without excess tension being placed in the suture by providing a wider opening into arocker recess 1027 as shown byFigs. 3D and4A . As such thegroove 1025b accommodates as it enters arocker recess 1027 in both afinal position 1041B as well as aninitial position 1041A of a rocker 1041 (Discussed further herein below). As such thesuture receiving groove 1025b enables thesuture 500 to be maintained out of the way of the advancingsuturing instrument 900 during use of thecartridge 1000. Additionallyrecess groove 1025b is in line withgrooves suturing instrument 900 to further facilitate transfer of suture from theseat 1022 within thebase 1020 into the needle 930'. In the illustrated embodiment, both the instrument receiving groove and the suture receiving groove exit into therocker recess 1027. - With reference now to
Fig. 3C in some examples thecartridge 1000 additionally provides an alignment feature comprising amoveable seat 1022. In some such examples, thecartridge 1000 comprises amagazine 1021 that is defined by thebase 1020 that functions to align the suture with a portion of thesurgical suturing instrument 900 that is receivable within thecartridge 1000. Themagazine 1021 defines theseat 1022 for releasably holding or retaining a portion of thesuture 500. More specifically, theseat 1022 is configured to hold anend portion 504 of thesuture 500 as shown. Themagazine 1021 is moveable with respect to thecartridge 1000 and as such defines amoveable seat 1022 for aligning thesuture end 504 held therein with a portion of thesurgical suturing instrument 900 that is received within thecartridge 1000. More particularly, as shown inFig. 3C , theseat 1022 is moveable with respect to thebase 1020. (Alternatively, in some examples theseat 1022 may be moveable relative to thechamber 1010 defined by housing 1010', for example in examples where thebase 1020 may be formed integrally with the housing 1010' forming a unitary cartridge 1000). - In some examples, particularly with reference to
Fig. 3C , theseat 1022 is automatically moveable upon insertion of thesuturing instrument 900 within thecartridge 1000. In the particular example shown, themagazine 1021 comprises arocker 1041 that is rotatable about apivot 1042, and thebase 1020 defines arocker recess 1027 for enabling pivotal movement of therocker 1041 therein. In the illustrated embodiment, thepivot 1042 is formed by laterally extendingpins 1043 of the rocker 1041 (also illustrated in 3G) that are held within pivot support openings 1023 of thebase 1020 and are moveable freely therein. Therocker 1041 is moveable about thepivot 1042 from itsinitial position 1041A (as shown inFig. 3C ) to its second position (as shown inFig. 4C(i) ) in order to align theseat 1022 and thesuture end 504 held therein with the path of an advancingsuturing instrument 900 that is inserted within thecartridge 1000. - In some examples, the
rocker 1041 is held in itsinitial position 1041A within therocker recess 1027 through frictional engagement. For example therocker 1041 may be kept in itsinitial position 1041A by an engagement feature such as a raised tab or detent [not shown] that is formed within thebase 1020 and may extend or juts into therocker recess 1027. The tab may be engageable with a portion of therocker 1041 to maintain the rocker in itsinitial position 1041A during shipment and prior to use. In other examples therocker 1041 may be held in itsinitial position 1041A through frictional engagement via a spring based mechanism. The frictional force may be sufficient to keep therocker 1041 in itsinitial position 1041A when the cartridge is empty, but maybe overcome upon contact with thesuturing instrument 900. Thus therocker 1041 may be released from engagement with thebase 1020 upon advancement of thesuturing instrument 900 within thecartridge 1000 allowing therocker 1041 to move into itssecond position 1041B to align the portion of the suture held therein with a portion of thesuturing instrument 900. In itssecond position 1041B, therocker 1041 moves into a cavity defined by therocker recess 1027. More specifically, as defined herein therocker 1041 is moveable into a rocker cavity 1027' of therocker recess 1027 to align theseat 1022 with thesuturing instrument 900. The rocker cavity 1027' is defined as a portion of therocker recess 1027 that corresponds to atissue receiving gap 942 of thesuturing instrument 900, upon loading of thecartridge 1000 onto the suturing instrument 900 [Fig. 3C ]. - In some examples, the cartridge may comprise additional features that assist in aligning the
seat 1022 with a portion of thesuturing instrument 900 as thesuture passing member 930 held within the shaft or instrument proximal portion orshaft 910. In one such example, referring again toFig. 3C , therocker 1041 additionally defines an instrument receiving or locking recess defined by agroove 1044 that is designed for receiving thesuturing instrument 900 as it is advanced distally. Thegroove 1044 functions as a restrain to position thesuturing instrument 900 in a desired position relative to theseat 1022 to assist in aligning theseat 1022 with asuture passing instrument 900. Thegroove 1044 enables therocker 1041 to pivot down into itssecond position 1041B while allowing thesuturing instrument 900 to be advanced into thecartridge 1000 to permit loading the suture into thesuturing instrument 900. [The operation of thegroove 1044 is discussed further herein below with reference toFigs. 4A-4D that illustrate the operation of the device]. As further shown inFigs. 3H and 3I , thegroove 1044 comprises a grooveproximal portion 1046 for receiving the instrument proximal portion orshaft 910 of thesuturing instrument 900, and additionally comprises a groovedistal portion 1048 for receiving the instrument distal portion ortip 920. - Additionally, the
rocker 1041 comprises a median 1047 that is defined by thegroove 1044. The groove proximal anddistal portions seat 1022 to enable the seat to be brought down into thetissue receiving gap 942. The median 1047 functions as an alignment feature by holding and aligning theseat 1022 with the suture passing member such as needle 930' of thesuturing instrument 900. As such median 1047 functions to holding the seat to enable theseat 1022 to be brought down into the cavity 1027'corresponding to the tissue receiving gap upon reception to the suturing instrument within the cartridge. - Still furthermore the
groove 1044 defines an additional alignment feature in the form of aninterior bevel face 1043 that is defined by the groovedistal portion 1048 of therocker 1041, along a distal end thereof. Thebevel 1043 enables thedistal portion 920 of the suturing instrument to pivot therocker 1041 from itsinitial position 1041A into its aligned position orsecond position 1041B to enable alignment of theseat 1022 and the suture held therein with thesuture passing member 930 of the suturing instrument. - In some examples, the
rocker 1041 additionally defines another alignment feature in the form of a slot 1049 (as shown inFigs. 3J ) and3L within thegroove 1044 to assist in alignment and transfer of thesuture end 504 into thesuture passing member 930. Theslot 1049 comprises a slit orchannel 1049a that is formed within a wall 1044' of therocker 1044 and extends transversally along the base of the wall 1044' to route the suture there-through upon exiting theseat 1022. The slit orchannel 1049a functions to retain thesuture 500 therein as it exits theseat 1022 within therocker 1041 to aid in routing thesuture 500 within thesuture receiving groove 1025b (Fig. 3D ) of thebase 1020 and to align the suture with thesuture receiving slot 928 in the shaft. The slit orchannel 1049 exists into a cut-out portion defined within the exterior wall of therocker 1041. The cutout defines aside slot 1049b defining a space enabling thesuture 500 to be routed there-through to be guided into thesuture receiving groove 1025b of thebase 1020. The slit orgroove 1049a is in communication with therocker side slot 1049b to hold the suture to the side within thesuture receiving groove 1025b of the base. This allows the suture to be held to the side of thesuturing instrument 900 during advancement of the suturing instrument within thecartridge base 1020. - In one specific example, as shown in
Figs. 3J and3K , theseat 1022 is defined by aprojection 1030 that is housed within themagazine 1021, specifically within therocker 1044. In one specific embodiment, the median 1047 comprises an axially extending channel or opening therein for receiving and retaining aprojection 1030 that defines theseat 1022. In some examples, the projection may be press-fit within the channel or opening. In other examples it may be coupled to the median using an adhesive. In other examples theprojection 1030 defining theseat 1022 may be formed in one piece as part of the rocker. Theprojection 1030 defines a hollow interior forming aseat channel 1024 and thesuture end 504 is press-fit within theseat channel 1024 to be held therein. As such theprojection 1030 forms an alignment feature to further aid in aligning theseat 1022 with thesuture receiving passage 932 of thesuture passing member 930 such as the needle 930' within theshaft 910. As shown inFigs. 3M and4D , theprojection 1030 extends into the instrument receiving recess defined by thegroove 1044. More specifically, theprojection 1030 is capable of abutting against/mating with the suture passing member 930 (such as needle 930') when brought into engagement therewith. In one specific example, theprojection 1030 defines abevel face 1034 for engaging with abevel face 934 of the needle 930' for docking the needle 930' to align theseat 1022 with the needle 930' with to permit transfer of thesuture end 504 from theseat 1022 into asuture receiving passage 932 of the needle 930'. In one specific example, theprojection 1030 is receivable into the instrument proximal portion orshaft 910 to facilitate alignment of theseat 1022 with the needle 930'. - In some such examples, as shown in
Fig. 3K , therocker 1041 comprises additional alignment features to assist in alignment of theseat 1022. In one such example theprojection 1030 comprises interference features in the form of raisedbumps 1045a on the exterior of theprojection 1030 that are configured to frictionally engage the interior of the instrument proximal portion orshaft 910 with the needle 930' as theprojection 1030 is received within theshaft 910. In additional examples, therocker 1041 also, as shown inFig. 3K and3M , thecartridge 1000 defines a suture groove or slot to allow the suture to exit theseat 1022. In some such examples, therocker 1041 defines a suture slot that is in communication with theseat 1022 for allowing the suture to exit theseat 1022. In the specific example shown the comprises additional raisedbumps 1045b along the interior of theproximal groove portion 1046 for frictionally engaging the exterior of the instrument proximal portion orshaft 910 once it is received within theproximal groove portion 1046 in order to align theseat 1022 with the needle 930'. This may be referred to as the needle-in configuration ofcartridge 1000 as the needle 930' remains inside theshaft 910 during loading of thesuturing instrument 900. - In some
examples projection 1030 defines asuture slot 1038 therein allowing thesuture 500 to exit therefrom to enable alignment of thesuture end 504 with thesuture receiving passage 932 within the needle 930'. More specifically, thesuture slot 1038 enables the suture to be to be routed through it upon exiting theseat 1022, such that suture is aligned with theneedle slot 928 andshaft slot 938. This facilitates transfer of the suture end into thesuture receiving passage 932 of theneedle 930 using a suture transferring component of thecartridge 1000. Once the suture exits thesuture slot 1038, it is routed though theslot 1049 of therocker 1041 to enable suture be held to the side of the rocker such that it is off to the side of the path of thesuturing instrument 900 as it is advanced into thecartridge 1000. - In an alternate example, as shown in
Fig. 3L and3N , the magazine, for example therocker 1041, comprises an alignment recess 1030' that is located adjacent the seat, for holding the suture therein. In some such examples, therocker 1041 defines an opening/space or such as a seat recess or seat channel that forms the seat 1022' for holding thesuture end 504 in frictional engagement therein. The alignment recess 1030' is positioned adjacent the seat 1022' and is in line with thesuture passing member 930. The alignment recess 1030' and is configured for receiving the suture passing member 930 (such as needle 930') therein, to allowsuture end 504 to be transferred from the seat 1022' to thesuture receiving passage 932 of thesuture passing member 930. The present configuration of thecartridge 1000 may be referred to as the needle-out configuration as the needle 930' is maintained in a partially extended position during loading of thecartridge 1000 onto thesuturing instrument 900, as shown inFig. 3N . In other words a distal portion of theneedle 930 extends distally outside theshaft 910 of the suturing instrument at the time of loading thecartridge 1000 onto the suturing instrument. For example, thesuture passing member 930 such as the needle 930' can be held in a partially extended position to allow the needle 930' to be receiving within the alignment recess 1030' for loading of suture therein. In some examples, a needle lock is provided that is mounted along the instrument proximal portion orshaft 910 of thesuturing instrument 900 and is engageable with anaperture 935 within the needle 930' in its locking position to maintain the needle 930' in the partially extended position during loading of thecartridge 1000 onto thesuturing instrument 900. The needle lock may be disengaged thereafter to allow the needle 930' to be retracted to its nominal position prior to use of thesuturing instrument 900. - In one specific example, as shown in
Fig. 3o , the needle lock comprises acam lock 937 comprising acam 939 within a cam housing 939'. In its locked position 937A as shown, the cam is engaged with theaperture 935 of the needle 930' preventing the needle 930' from retracting into the instrument proximal portion orshaft 910. As such thecam 939 allows the needle 930' to remain in its partially extended position to allow the needle 930' to be received within the alignment recess 1030' of thecartridge 1000 facilitating alignment and transfer of suture end form the seat 1022' into the needle 930'. Thecam 939 may then be disengaged from theneedle aperture 935 thereafter moving thecam lock 937 into its unlocked position which the needle 930' to retract back into the shaft or instrumentproximal portion 910. In some examples, a component of thecartridge 1000, for example a component of the cartridge housing 1010' may moveable proximally along the instrument proximal portion ofshaft 910 to disengage the cam lock moving it into its unlocked position to allow the needle to move into its unactuated/nominal position. - In some such examples, as shown in
Fig. 3L , therocker 1041 comprises additional alignment features to assist in alignment of the seat 1022'. In one such example, the alignment recess 1030' adjacent the seat 1022' comprises interference features for frictionally engaging an exterior of the needle 930' of thesuturing instrument 900 upon advancement of the needle 930' into the alignment recess 1030'. More specifically, thecartridge 1000 comprises interference features in the form of raisedbumps 1045a on the inner surface of the wall defining the alignment recess 1030'. The raisedbumps 1045a extend proximally along the inner surface of the wall of the alignment recess 1030' and are configured to frictionally engage the exterior of the needle 930' as the needle 930' is received within the alignment recess 1030'. As outlined previously herein above for the embodiment illustrated inFig.3k , therocker 1041 shown inFig. 3L , also comprises additional raisedbumps 1045b along the interior of theproximal groove portion 1046 for frictionally engaging the exterior of the instrument proximal portion orshaft 910 once it is received within theproximal groove portion 1046 in order to align theseat 1022 with the needle 930'. This may be referred to as the needle-out configuration of thecartridge 1000 as the needle 930' remains partially extended outside the distal end of theshaft 910, during loading of thecartridge 1000 onto thesuturing instrument 900. - In some examples, as shown in
Fig. 3L , thecartridge 1000 defines a suture groove or slot to allow the suture to exit theseat 1022. In some such examples, therocker 1041 defines a suture slot that is in communication with theseat 1022 for allowing the suture to exit theseat 1022. In the specific example shown inFig. 3L , the alignment recess 1030' defines a suture slot 1038' therein allowing thesuture 500 to exit therefrom to enable alignment of thesuture end 504 with thesuture receiving passage 932 within the needle 930'. More specifically, the suture slot 1038' enables the suture to be to be routed through it upon exiting theseat 1022, such that suture is aligned with theneedle slot 928 andshaft slot 938. This facilitates transfer of the suture end into thesuture receiving passage 932 of theneedle 930 using a suture transferring component of thecartridge 1000. Once the suture exits the suture slot 1038', it is routed though theslot 1049 of therocker 1041 to enable suture be held to the side of the rocker such that it is off to the side of the path of thesuturing instrument 900 as it is advanced into thecartridge 1000. - In some examples, the
rocker 1041 additionally comprisesinterference tabs 1048x (as shown in 9M) for engagement with thesuturing instrument 900 which allow therocker 1041 to over-rotate to ensure alignment of therocker 1041 with the instrument proximal portion orshaft 910 of thesuturing instrument 900 to allow advancement of therocker 1041 along theshaft 910. In other words theinterference tabs 1048x may allow therocker 1041 to rotate sufficiently to enable theseat 1022 to be positioned adjacent thesuturing instrument 900 by ensuring that theshaft 910 is received within the rocker grooveproximal portion 1046. For example where theseat 1022 is defined by theprojection 1030, the interference tabs allow therocker 1041 to rotate sufficiently to enable theprojection 1030 to be received within the instrument shaft 910.Whereas, where theseat 1022 is positioned adjacent an alignment recess (as discussed earlier with reference toFig. 3N , the interference tabs allow therocker 1041 to rotate sufficiently such that the alignment recess and theseat 1022 adjacent to it are both aligned with the needle 930'. - As outlined previously herein, with reference to
Fig. 3A-3C some examples define base 1020 that is detachably coupled to the housing 1010' enabling thebase 1020 and the housing 1010' to operate as a single unit upon loading of thecartridge 1000 onto thesuturing instrument 900 where both thebase 1020 and the housing 1010' provide features to assist in alignment of a portion of thesuture 500 such as asuture end 504 with thesuture passing member 930. In some such examples, the housing 1010' additionally comprises a means to frictionally engage a portion of the suture and is detachable from thebase 1020 after alignment of the suture portion with thesuture passing member 930 to transfer the suture portion into the suture passing member. In one such example as described further herein below the means to frictionally engage a portion of the suture comprises a suture lock. - As such, the cartridge housing 1010' defines a
suture transferring component 1011 to transfer of the suture end into thesuture passing member 930. In one embodiment as shown and described herein thesuture transferring component 1011 is operable to pull the portion of the suture that is held in frictional engagement in order to transfer the suture portion such assuture end 504 held within theseat 1022, onto thesuturing instrument 900. As such thecartridge 1000 comprises asuture transferring component 1011 that forms or defines a pull mechanism as described further in the method outlined herein below. The pull mechanism is defined as the mechanism of the cartridge that enables a pulling force to be exerted or applied to the suture portion such as the suture end to transfer the suture portion from the seat into the suturing instrument. In some examples the housing 1010' may additionally comprise suture loops that form a partially pre-tied knot that are mounted about the housing 1010'. Additionally in some examples the housing 1010' may provide a means to house excess suture. In one example, the excess suture may be provided on spools that are carried by housing 1010'. - In some examples as shown in
Figs 3B ,3C and3G , thecartridge base 1020 is detachably coupled to the cartridge housing 1010' via an interlock. In the specific example shown, the cartridge housing 1010' defining thesuture transferring component 1011, comprises aninterlock 1050. Theinterlock 1050 secures the base 1020 to the housing 1010' (and thus the suture transferring component) allowing thecartridge 1000 to operate a single functional unit upon loading of thecartridge 1000 onto thesuturing instrument 900, until theseat 1022 is aligned with thesuturing passing member 930. Theinterlock 1050 may then be disengaged to allow the housing 1010' that defines thesuture transferring component 1011 to translate independently along thesuturing instrument 900 to transfer thesuture end 504 from theseat 1022 into thesuture passing member 930 of thesuturing instrument 900.Figs.5A-5C , illustrate theinterlock 1050 in its initial lockedposition 1050A, with theinterlock arms 1056 of theinterclock 1050 being axially aligned with the lockingarms 1026 of the base. Theinterlock arms 1056 prevent movement of the housing 1010' with respect to thebase 1020 to form acartridge unit 1000 by blocking longitudinal movement of the lockingarms 1026 of the base 1020 (and as such block the longitudinal movement of the base 1020). The function of theinterlock 1050 is described further herein below with respect toFigs. 5A-6B . Theinterlock 1050 is moveable into itsunlocked position 1050B to allow the housing 1010' to be disengaged from thebase 1020. In some examples, theinterlock 1050 comprises a manual interlock that is moveable into theunlocked position 1050B to manually disengage the housing 1010' (and thus thesuture transferring component 1011 defined thereby) from thebase 1020 upon alignment of theseat 1022 with thesuture passing member 930. - Still furthermore, suture transferring component defined by the housing 1010' comprises a means to hold a portion of the
suture 500 in frictional engagement with the housing 1010' to allow the housing 1010' to move thesuture 500 therewith to enable the housing 1010' to transfer thesuture end 504 held within theseat 1022 of the base to thesuture passing member 930. In the embodiment shown inFigs 3C and3G , a portion of the suture is held in frictional engagement with asuture lock 1060 to secure thesuture 500 thereto to enable the housing to pull thesuture end 504 by applying tension to the suture (for example a segment of suture held in frictional engagement within the housing, for example via a suture lock) from theseat 1022 into thesuture passing member 930. - More specifically, in the embodiment shown, the
suture 500 is held within thecartridge 1000 such that thesuture 500 is routed from thesuture end 504 within theseat 1022 upon exiting theseat slot 1038 such that it enters theslot 1049 of the rocker to be routed there-through. More specifically, in some examples the suture passed through and pinched within the slit orchannel 1049 such that it is held therein in a force fit engagement. Thesuture 500 then enters theside slot 1049b on the exterior face of the rocker 1041 [Figs 3J and3L ]. Thesuture 500 exits therocker 1041 into therocker recess 1027 and is routed through therecess groove 1025b within thebase 1020 which allows thesuture 500 to be maintained withinrecess groove 1025b adjacent and out of the way of the path of thesuturing instrument 900 to be inserted through therecess groove 1025a [Fig. 3D ]. The suture is then routed through anopening 1051 within the interlock and guided into asuture channel 1061 to engage with thesuture lock 1060 In one particular embodiment, as shown inFigs. 7A-7E thesuture lock 1060 comprises projections orteeth 1064 defining contours or ridges and valleys that are configured to engage corresponding features in the form or projections orteeth 1064 within a suturelock engaging component 1062 of the housing 1010'. Thesuture 500 is routed through the suturelock engaging component 1062 of the housing 1010' and thesuture lock 1060 is press fit to engage with the suturelock engaging component 1062 pressing the suture between the two, and as such coupling the suture to the housing 1010'.Figs. 7B and7E show the lock in its initial lockedconfiguration 1060A. Thelock 1060 remains in its locked configuration until the suture portion such as the end of the suture has been loaded into thesuturing instrument 900. It is moveable thereafter into its second of unlocked configuration as shown inFigs.7C and7D and additionally inFig. 7F to allow thesuture 500 to be disengaged from the housing 1010'. - In some examples, as described herein above in example 3, the movement of the
suturing instrument 900 may be a relative movement with respect to thecartridge 1000. In other words the user may move thecartridge 1000 axially over thesuturing instrument 900 in a proximal direction while the suturing instrument is held by the user in order to create a relative advancement of thesuturing instrument 900 with respect to thecartridge 1000 in order to load the suture onto thesuturing instrument 900. This may be refer to as loading of suture using pumping action. As such, the mechanism of loading of the suture may remain as described above but the movement may be created either by the proximal movement of the cartridge over the suturing instrument or the distal movement of the suturing instrument within the cartridge. - In some examples as described herein, the cartridge is configured to align and transfer the suture upon a single linear motion of the cartridge with respect to the suturing instrument. In some such examples, the
interlock 1050 may be automatically disengaged upon alignment of the suture end within the seat with the suture passing member to enable automatic transfer of thesuture end 504 into the suture passing member as the housing 1010' is continued to be pulled proximally. Additionally thesuture lock 1060 may be automatically disengaged thereafter upon transfer of the suture end from theseat 1022 into thesuture passing member 930, which would allow the suturing instrument to be able to pass the suture in order to suture therewith. In some such examples, the cartridge is loaded onto thesuturing instrument 900 with a single linear movement. In some such examples a single pumping action is used involving a single linear relative movement of the cartridge onto the suturing instrument and removal of the base 1020 [for example via a linear movement in the opposing direction to the loading direction] thereafter leaving the housing coupled to the suturing instrument for example to mount a pre-tied knot held therein onto the suturing instrument. - In an alternate embodiment of the present invention, as shown in
Figs. 8A-8C , acartridge 2000 is disclosed for loading suture onto a surgical suturing instrument, for example asuturing instrument 900 as discussed previously herein above with reference toFigs. 1D and 1E . Similar to examples described previously herein above, thecartridge 2000 carries suture therein and allows suture to be loaded onto asurgical suturing instrument 900 for example, at the point of use. Thecartridge 2000 functions to align the suture with thesuturing instrument 900 upon insertion and relative axial advancement of thesuturing instrument 900 within thecartridge 2000, and additionally functions to transfer of the suture onto thesurgical suturing instrument 900. In some such examples, either thesuturing instrument 900 may be advanced distally into thecartridge 2000 or thecartridge 2000 may be pulled proximally over the suturing instrument. As described herein either of these techniques may be utilized to provide the functionally described herein for creating relative axial movement between thecartridge 2000 and thesuturing instrument 900 for loading the suture onto thesuturing instrument 900. This is also applicable to examples described herein above in example 3. In some such examples, thecartridge 2000 additionally provides a pre-tied knot therein and enables the pre-tied knot to be loaded onto thesuturing instrument 900. In some examples, the pre-tied knot may comprise loops that substantially form a pre-tied knot. In other words a pre-tied knot may comprise a partially pre-tied knot. In some such examples, the partially pre-tied knot is configured to be deployed from the suturing instrument after suturing to form a knot to secure the suture. - With reference now to
Figs. 8B and8C , the cartridge comprises a housing 2010' that defines achamber 2010 for axially receiving thesurgical suturing instrument 900. Thecartridge 2000 further comprises a base 2020 that is detachably coupled to the housing 2010', thebase 2020 defining a seat 2022 for releasably holding the suture therein [As shown inFig.8E(ii) ]. Thebase 2020 enables alignment of the suture held therein with thesuture passing member 930 of thesuturing instrument 900. The housing 2010' additionally comprises a suture transferring component to transfer suture from thebase 2020 onto thesurgical suturing instrument 900. Thus, in some examples, as shown inFig. 8B thebase 2020 and the housing 2010' comprise separate components of thecartridge 2000 that are coupled to one another to assist in loading suture and may be detachable therefrom to assist in transferring suture. The housing 2010' additionally comprises achamber 2010 therein and a means for securing or mounting apre-tied knot 502 about thechamber 2010, to enable the pre-tied knot to be mounted onto thesuturing instrument 900. The housing 2010' and thebase 2020 collectively provide alignment features to assist in alignment of the suture upon loading of thecartridge 2000 onto thesuturing instrument 900 to facilitate transfer of suture from thecartridge 1000 onto thesuturing instrument 900 using the suture transferring component. In some examples the housing 2010' comprises aknot slider 2030 that defines thechamber 2010, theknot slider 2030 includes suture loops coupled thereto, the suture loops are configured to form a knot upon deployment thereof from theknot slider 2030, wherein thesuturing instrument 900 is receivable within thechamber 2010 for mounting the suture loops onto the suturing instrument. - In some such examples, a suturing system is provided that comprises a
suturing instrument 900 comprising asuture passing member 930; and a cartridge (such as cartridge 2000) for releasably holding an end of a suture and defining achamber 2010 for coupling a partially pre-tied knot thereabout, thechamber 2010 is configured to receive thesuturing instrument 900 therethrough. Thecartridge 2000 is configured to transfer thesuture end 504 into to thesuture passing member 930 and to transfer the partially pre-tied knot (for example 502) onto the suturing instrument. In some such examples thesuture passing member 930 is configured to pass thesuture end 504 from a proximal side of a tissue to a distal side of the tissue in a first actuation of the suture passing member. - In an additional embodiment, a cartridge (such as cartridge 2000) is provided for loading suture onto a
suturing instrument 900 to enable the suturing instrument to form a pre-tied knot, the cartridge comprises: achamber 2010 for receiving asuturing instrument 900, thechamber 2010 supporting loops of suture coupled thereto (such asloop 502 shown inFig. 8B ) for transferring onto thesuturing instrument 900 upon advancement of the suturing instrument into thechamber 2010, the loops 502' of suture being configured to form a pre-tied knot upon deployment from the suturing instrument; and aseat 1022 for releasably holding a portion of the suture to enable transfer of thesuture portion 504 onto the suturing instrument, the suture portion comprising an end of the suture configured to define a post of the pre-tied knot upon deployment of the loops from the suturing instrument. - In one particular embodiment, the cartridge housing 2010' is detachably coupled to the
base 2020 and defines achamber 2010 for receiving thesurgical suturing instrument 900 there-through. In some such examples, thechamber 2010 additionally comprises a means for storing a pre-tied knot about the chamber. In some examples, the housing 2010' additionally comprises aknot slider 2030 defining thechamber 2010 having a pre-tied knot mounted thereon wherein the surgical suturing instrument is receivable within thechamber 2010 to mount the pre-tied knot onto thesurgical suturing instrument 900. In one particular example, the cartridge housing 2010' comprises an outer housing sleeve 2011' that defines a hollow interior for holding theknot slider 2030 therein. Theknot slider 2030 is detachably coupled to the housing sleeve 2011' and forms a part of the housing 2010'. In a particular example as shown inFig. 8B , theknot slider 2030 is detachably coupled to the housing 2010' via thebase 2020 for holding a pre-tied knot about thechamber 2010. - Additionally, the
chamber 2010 includes a recess orchannel 2014 that is a part of the chamber that receives the suturing instrument. In the particular example discussed herein thechamber 2010 defines achannel 2014 as shown inFig. 8D which illustrates a rear view of theknot slider 2030 to allow a portion thesuturing instrument 900 to be received there-through As such thechannel 2014 defines an instrument receiving recess for receiving thesuturing instrument 900 that additionally functions as a restraint for maintaining the position of thesuturing instrument 900 as it is advanced through thecartridge 2000. Similar to Example 3 described previously herein above, in some examples, thechannel 2014 comprises aproximal opening 2016 that narrows towards the interior of theknot slider 2030 as defined by a beveled interior edge 2016'. The beveled interior edge 2016' functions as a lead in to guide thesuturing instrument 900 into thechannel 2014. - The
channel 2014 extends longitudinally through theknot slider 2030 of the housing 2010' and is in communication with abase recess 2025 within thebase 2020. As shown inFigs 8A-8C , thebase 2020 is detachably coupled to the housing 2010'. More specifically, thebase 2020 is held within the housing sleeve 2011'. In some examples thechannel 2014 may be formed continuously with thebase recess 2025 within thecartridge base 2020. One example of this discussed further herein below. Thechannel 1014 and thebase recess 1025 both function as a restraint 25 (Fig.8E(i) ), to constrain or restrict the lateral and transverse movement of thesuturing instrument 900 within thecartridge 2000 while allowing thesuturing instrument 900 to be advanced linearly or axially therein in sliding engagement to maintain the position of thesuturing instrument 900 along the longitudinal axis as it is advanced. As such therestraint 25 constraints or limits the movement of thesuturing instrument 900 in the transverse and lateral directions as well along a longitudinal path defined thereby. Thus therestraint 25 facilitates alignment of thesuturing instrument 900 with a portion of thesuture 500 that is held within aseat 1022 defined by the base 20207 More specifically, thechannel 1014 and therecess 1025 allow thesuturing instrument 900 to be advanced therein in sliding engagement therein and additionally function to restrain thesuturing instrument 900 in a linear path as it is advanced along thecartridge 2000 to allow theseat 1022 to be aligned with thesuture receiving passage 932 of thesuture passing member 930. - Furthermore, similar to examples discussed previously with respect to Example 3 herein above, the
recess 2025 within the base is formed from two grooves, aninstrument receiving groove 2025a defining an instrument receiving recess as shown inFig. 8E(i) and Fig. 8E(ii) and asuture receiving groove 1025b defining a suture receiving recess, as shown inFig. 8F(i) and Fig. 8F(ii) . The instrument andsuture receiving grooves halves Figs. 8E(i)-Fig.8F(ii) ). - With reference again to
Figs. 8E(i),(ii) theinstrument receiving groove 2025a defines an instrument receiving recess by providing a track which functions as arestraint 25 to allow thesuturing instrument 900 to be advanced therein, whereassuture groove 2025b (Figs.8F(i) ) provides a track to guide the portion of the suture held within the seat into thesuture passing member 930 of thesuturing instrument 900 by maintaining/routing thesuture 500 therein such that it is adjacent and in line with the shaft orproximal portion 910 of thesuturing instrument 900 that is receivable within theinstrument receiving groove 2025a as further illustrated inFigs. 8F(ii) and 8G . More specifically, thesuture receiving groove 2025b allows the suture to be routed such that when the suturing instrument is received within theinstrument receiving recess 2025b, thesuture 500 is held adjacent thegroove 928 within the shaft or the instrumentproximal portion 910 as well groove 938 withinsuture passing member 930 such as needle 930' (shown in Fig. IE). Furthermore, thegroove 2025b provides room for routing the suture without excess tension being placed in the suture by providing a wider opening into arocker recess 2027 as shown byFig. 8F(ii) . As such thegroove 2025b accommodates the suture as it enters arocker recess 2027 in both afinal position 1041B as well as aninitial position 1041A of a rocker 1041 (Discussed further herein below). As such thesuture receiving groove 2025b enables thesuture 500 to be maintained out of the way of the advancingsuturing instrument 900 during use of thecartridge 2000. Additionallyrecess groove 2025b is in line withgrooves suturing instrument 900 to further facilitate transfer of suture from a seat 2022 for example within therocker 1041 within thebase 2020 into the needle 930'. In the illustrated embodiment, both the instrument receiving groove and the suture receiving groove exit into therocker recess 2027. - In some examples as provided herein the
cartridge 2000 additionally provides a pre-tied knot and a means to load the pre-tied knot onto thesuturing instrument 900. In some such examples, the cartridge defines achamber 2010 and a means to mount or retain a pre-tied knot about thechamber 2010. In one such example as discussed herein aknot slider 2030 is provided with reference toFig. 8C that enables a pre-tied knot to be mounted thereon so that it is held about and surrounds or circumscribes thechamber 2010. This enables thesuturing instrument 900 to be received through achannel 2014 within thechamber 2010 such that is passes through the pre-tied knot to allow the pre-tied knot to be mounted thereon. In one specific example the knot slider forms amount 2012" for holding thepre-tied knot 502 about thechamber 2010, as shown inFigs. 8B and8C . Thepre-tied knot 502 may be of the type as previously illustrated herein inFig. 1A . In some examples, theknot slider 2030 forms an instrument mounted component of thecartridge 2000. - Additionally some examples provide a means to hold the
knot slider 2030 within thecartridge 2000 to permit theknot slider 2030 to be held therein until asuturing instrument 900 is inserted within thecartridge 2000 to enable theknot slider 2030 to be detached from the rest of thecartridge 2000 to be coupled to thesuturing instrument 900 thereafter. In some such examples, theknot slider 2030 is held within a knot slider recess 2018 (Fig. 8B andFig. 8C ) within the outer sleeve 2011' and is detachably coupled thereto via thebase 2020. In one particular example, theknot slider 2030 is detachably coupled to thebase 2020 via a knotslider release interlock 2033 that for example comprises a snap fit arrangement as shown inFig. 8H(i) As additionally illustrated inFigs. 8E(i) ,8F(i) , the base comprises snaparms 2042 that are receivable within and engageable with grooves formed within theknot slider 2030 that may be referred to assnap grooves 2032 to coupleknot slider 2030 therein, forming the knotslider release interlock 2033. In order to facilitate coupling between theknot slider 2030 and thebase 2020, thebase 2020 additionally comprises a knot slider s 2040 therein that is configured for receiving a portion of theknot slider 2030 therein. - In the illustrated embodiment, the
knot slider 2030 is detachable from the base to enable loading of theknot slider 2030 and thus thepre-tied knot 502 onto thesuturing instrument 900 upon disengagement of the knotslider release interlock 2033. In one specific embodiment, theknot slider 2030 is detachable from thebase 2020 upon relative movement of base 2020 with respect to the housing 2010'. In one such example, theknot slider 2030 is moveable distally along theknot slider recess 2018 within the housing sleeve 2011' upon distal movement of thebase 2020 within the housing sleeve 2011'. However, the wall 2019'of the housing sleeve 1011' adjacent the tapered inner wall 2019 [Fig. 8B ] of theknot slider recess 2018 functions as a stop to prevent further distal movement of theknot slider 2030 to disengagesnap arms 2042 of the base 2020 from the snap grooves of theknot slider 2030, and as such disengages the knotslider release interlock 2033. - In some examples, the
cartridge 2000 defines amoveable seat 1022 as previously described herein above with reference toFig. 3C , theseat 1022 is automatically moveable upon insertion of thesuturing instrument 900 within thecartridge 2000. In the particular example shown, thecartridge 2000 comprises amagazine 1021 comprising arocker 1041 that is rotatable about a pivot, and thebase 2020 defines arocker recess 2027 for enabling pivotal movement of therocker 1041 therein. Similar to the examples illustrated inFigs 3C and4C(i) , therocker 1041 is moveable about thepivot 1042 from itsinitial position 1041A (as shown inFig.9A(i) ,(ii) ) to itssecond position 1041B (as shown inFig.9B(i),(ii) ) in order to align theseat 1022 and thesuture end 504 held therein with the path of an advancingsuturing instrument 900 that is inserted within thecartridge 2000. As outlined previously in example 3, as defined herein therocker 1041 is moveable within therocker recess 2027. Therocker 1041 is moveable from itsfirst position 1041A into a rocker cavity 2027' itssecond position 1041B, as shown inFig. 9B(ii) . The rocker cavity 2027' is defined as a portion of therocker recess 2027 that corresponds to thetissue receiving gap 942 of thesuturing instrument 900 once suturinginstrument 900 is positioned within thebase 2020 of thecartridge 2000 upon loading of thecartridge 2000 onto the suturing instrument. - In some examples, the
rocker 1041 is held in itsinitial position 1041A within therocker recess 2027 through frictional engagement. For example therocker 1041 may be kept in itsinitial position 1041A by an engagement feature such as a raised tab ordetent 2029 as shown inFigs. 8C and8F(i) , that frictionally engages therocker 1041. The tab ordetent 2029 is formed within thebase 2020 and may extend or jut into therocker recess 2027. Thetab 2029 is engageable with a portion of the rocker 1041(for example a nose portion 1081) of therocker 1041 as shown inFig. 8F(ii) , to maintain the rocker in itsinitial position 1041A during shipment and prior to use. - In some examples, for example as provided in Example 4, the
cartridge 2000 may comprise additional features that assist in aligning theseat 1022 with a portion of thesuturing instrument 900 as thesuture passing member 930 held within the shaft or instrument proximal portion orshaft 910. In one such example, with reference earlier toFig. 3C , therocker 1041 additionally defines an instrument receiving or locking recess defined by agroove 1044 that is designed for receiving thesuturing instrument 900 as it is advanced distally. Thegroove 1044 functions as a restrain to position thesuturing instrument 900 in a desired position relative to theseat 1022 to assist in aligning theseat 1022 with asuture passing instrument 900. As shown and discussed previously with reference toFigs. 3H and 3I , thegroove 1044 comprises a grooveproximal portion 1046 for receiving the instrument proximal portion orshaft 910 of thesuturing instrument 900, and additionally comprises a groovedistal portion 1048 for receiving the instrument distal portion ortip 920. - As discussed earlier with respect to Example 3, the
rocker 1041 of Example 4 additionally comprises a median 1047 (Fig.9A(i) that is defined by thegroove 1044 that functions as an alignment feature by holding and aligning theseat 1022 with the suture passing member such as needle 930' of thesuturing instrument 900. - Still furthermore, the
groove 1044 defines an additional alignment feature in the form of an interior bevel face 1043 (Fig.9A(i) ) within thedistal groove portion 1048 to enables thedistal portion 920 of the suturing instrument to pivot therocker 1041 from itsinitial position 1041A into its aligned position orsecond position 1041B to enable alignment of theseat 1022 and the suture held therein with thesuture passing member 930 of the suturing instrument. - In some examples, in
cartridge 2000, therocker 1041 additionally defines another alignment feature in the form of a rocker slot 1049 (as shown earlier inFigs. 3J ,3L ) within thegroove 1044 to assist in alignment and transfer of thesuture end 504 into thesuture passing member 930. Theslot 1049 comprises a slit orchannel 1049a (also shown inFig.9A(i) ) that exit into aside slot 1049b within therocker 1041, to aid in routing thesuture 500 within thesuture receiving groove 2025b (Fig. 8F(ii) ) of the base 2020 to assist in aligning the suture with thesuture receiving slot 928 in the shaft. This allows the suture to be held to the side of thesuturing instrument 900 out of the way of the path of the advancing suturing instrument during advancement of the suturing instrument within thecartridge base 2020. As such therocker 1041 defines arocker slot 1049 for routing thesuture 500 there-through to enable thesuture 500 to be kept out of the way of a path of thesuturing instrument 900 upon advancement of thesuturing instrument 900 therein. For example when a portion of the instrumentproximal portion 910 is received within the grooveproximal portion 1046 of therocker groove 1044. - In one specific example, as shown in
Figs. 3J and3K , theseat 1022 is defined by aprojection 1030 that is housed within themagazine 1021, specifically within therocker 1041. As shown inFig. 3M and4D , theprojection 1030 extends into the instrument receiving recess defined by the groove 1044 (specifically, the groove proximal portion 1046). More specifically, the median functions to hold theprojection 1030 within the grooveproximal potion 1046 of the rocker. In some examples theprojection 1030 defining theseat 1022 may be formed in one piece as part of the rocker. Theprojection 1030 additionally defines abevel face 1034 for engaging with abevel face 934 of the needle 930' for docking the needle 930' to align theseat 1022 with the needle 930' with to permit transfer of thesuture end 504 from theseat 1022 into asuture receiving passage 932 of the needle 930'. In one specific example, theprojection 1030 is receivable into the instrument proximal portion orshaft 910 to facilitate alignment of theseat 1022 with the needle 930'. - Alternatively, the rocker may define a seat recess or seat channel and an alignment recess 1030' that is located adjacent the
seat 1022. As shown and described further herein with respect toFigs. 3L and3N , the alignment recess 1030' is configured for receiving thesuture passing member 930 such as needle 930' in its needle out configuration to align the seat with the suture passing member. - In some such examples, as shown in
Fig. 3K , therocker 1041 comprises additional alignment features such as interference features in the form of raisedbumps 1045a on the exterior of theprojection 1030 that are configured to frictionally engage the interior of the instrument proximal portion orshaft 910 with the needle 930' as theprojection 1030 is received within theshaft 910. Therocker 1041 additionally comprises additional raisedbumps 1045b along the interior of theproximal groove portion 1046 for frictionally engaging the exterior of the instrument proximal portion orshaft 910 once it is received within theproximal groove portion 1046. The raisedbumps seat 1022 with the needle 930'. - In some
examples projection 1030 defines asuture slot 1038 therein allowing thesuture 500 to exit therefrom to enable alignment of thesuture end 504 with thesuture receiving passage 932 within the needle 930'. - In some examples, the
rocker 1041 additionally comprisesinterference tabs 1048x ((as shown inFig.9A (iii) , andFig.9B (i) as discussed earlier with respect toFig. 3M ) for engagement with thesuturing instrument 900 which allow therocker 1041 to over-rotate to ensure alignment of therocker 1041 with the instrument proximal portion orshaft 910 of thesuturing instrument 900 to allow advancement of therocker 1041 along theshaft 910. In other words theinterference tabs 1048x may allow therocker 1041 to rotate sufficiently to enable theseat 1022 to be positioned adjacent thesuturing instrument 900 by ensuring that theshaft 910 is received within the rocker grooveproximal portion 1046. For example where theseat 1022 is defined by theprojection 1030, the interference tabs allow therocker 1041 to rotate sufficiently to enable theprojection 1030 to be received within theinstrument shaft 910. Whereas, where theseat 1022 is positioned adjacent an alignment recess (as discussed earlier with reference toFig. 3N , the interference tabs allow therocker 1041 to rotate sufficiently such that the alignment recess and theseat 1022 adjacent to it are both aligned with the needle 930'. - As outlined previously herein, with reference to
Fig. 8A-8C some examples provide a housing sleeve 2011' that is detachably coupled to thebase 2020 and remains coupled to thebase 2020 to operate as a single unit upon loading of thecartridge 2000 onto thesuturing instrument 900. The housing sleeve 2011' remains coupled to thebase 2020 until theseat 1022 is aligned with thesuture passing member 930 of thesuturing instrument 900. The cartridge sleeve 2011' is detachable from thebase 2020 thereafter to transfer suture from base 2020 into thesuturing instrument 900. As such, the cartridge housing 2010' defines asuture transferring component 2011. - In some examples as shown in
Figs 8B , thecartridge base 2020 is detachably coupled to thesuture transferring component 2011 of the housing 2010' via aninterlock 2050. Theinterlock 2050 secures the base 2020 to the housing 2010' in itsinitial position 2050A may then be disengaged to move into itssecond position 2050B [shown later inFigs. 9D[i],[ii] ) to allow the housing sleeve 2011' that comprises thesuture transferring component 2011 to translate independently relative to thebase 2020 to transfer thesuture end 504 from theseat 1022 into thesuture passing member 930 of thesuturing instrument 900.Figs. 9B[i],[ii] and9C[i],[ii] , illustrate theinterlock 2050 in its initial lockedposition 2050A, with aninterlock arm 2056 being axially aligned with and being position distal to thebase 2020 preventing longitudinal movement of the base 2020 with respect to the housing 2010'. Theinterlock 2050 is moveable to itsunlocked position 2050B (as shown inFigs. 9D[i],[ii] ) to disengage the transferring component from the base to enable relative movement there-between upon alignment of the seat with a suture passing member of the suturing instrument. The function of theinterlock 2050 is described further herein below with respect toFigs. 9C[i]-9D[ii] . In some examples, theinterlock 2050 comprises a manual interlock that is moveable into theunlocked position 2050B to manually disengage thesuture transferring component 2011 from thebase 2020 upon alignment of theseat 1022 with thesuture passing member 930. - In some examples, the
interlock 2050 comprises an automatic interlock (Fig. 9A[i] ) that functions to automatically disengage thesuture transferring component 2011 from thebase 2020 upon alignment of theseat 1022 with thesuture passing member 930. In some such examples, the operation of theinterlock 2050 is partially automatic wherein theinterlock 2050 comprises an interlock tab 2054 (as shown inFig.9A[i] ), that is automatically disengaged upon alignment of theseat 1022 with thesuture passing member 930 to enable theinterlock 2050 to be moved manually into itsunlocked position 2050B (Fig.9E[i] ). This enables the base 2020 to be disengaged from thesuture transferring component 2011. More specifically, therocker 1041 comprises arocker bar 2055 that is moveable upon alignment of theseat 1022 to disengage theinterlock tab 2054. This is discussed further herein below with reference toFigs. 9A[i]- 9B[ii] . - In some examples, as shown in
Fig.9A[i] , thesuture transferring component 2011 comprises apush rod 2058, wherein thesuture transferring component 2011 is moveable with respect to thebase 2020 to enable movement of the base 2020 therein to engage apush rod 2058 to push thesuture end 504 held within theseat 1022 to transfer it to thesurgical suturing instrument 900. In some such examples thepush rod 2058 comprises apush rod hub 2057 that is configured to translate within push rod cavity 2057'. In some such examples, thesuture transferring component 2011 comprises asleeve push hub 2012 to push thepush rod hub 2057 once in engagement therewith. In some examples thepush sleeve hub 2012 is moveable within a sleeve cavity 2012' and is biased towards thebase 2020. In one specific example thepush sleeve hub 2012 is biased via a spring mechanism. In a specific instance of this example, the spring mechanism comprises twosprings 2013. Thepush sleeve hub 2012 is configured to push thepush rod hub 2057 upon translation of thesuture transferring component 2011 with respect to thebase 2020. As such thesuture transferring component 2011 comprises a hub, such assleeve push hub 2012 that is biased towards thebase 2020 to push thepush rod 2058 upon engagement with thepush rod 2058 upon translation of thebase 2020 within the housing sleeve 2011'. In one example, thesleeve push hub 2012 is biased via a spring mechanism. - In one specific example, the
push rod 2058 comprises a longitudinally extending wire 2053' coupled to thepush rod hub 2057 that is translatable within awire channel 2053 in communication with theseat 1022 for receiving the wire 2053' therein to push thesuture end 504 held within theseat 1022 into asuture receiving passage 932 of thesuturing instrument 900. As such thecartridge 2000 comprises asuture transferring component 2011 defines a push mechanism as described herein above. The push mechanism is defined as the mechanism of the cartridge that enables a pushing force to be applied to the suture portion such as the suture end to transfer from the seat into the suturing instrument. In one such example the push mechanism comprises apush rod 2058 as described above. - In some examples, the cartridge 200 is configured to align and transfer the
suture end 504 upon a single linear movement of thecartridge 2000 with respect to thesuturing instrument 900. As outlined above in some such examplessurgical suturing instrument 900 comprises asuture passing member 930 defining asuture receiving passage 932 wherein thesuture transferring component 2011 that is operable to transfer an end of thesuture 500 from theseat 1022 within thebase 2020 into thesuture receiving passage 932 of thesuturing instrument 900. - In some examples, as shown in
Fig. 8C , theknot slider 2030 is coupled to thesuturing instrument 900. In one such example theknot slider 2030 configured to be slidably engaged with a portion of the surgical suturing instrument to allow theknot slider 2030 to be mounted thereon. In one particular example, theknot slider 2030 is engageable in sliding contact with a portion of thesuturing instrument 900 for positioning theknot slider 2030 along the suturing instrument to facilitate deployment of thepre-tied knot 502 from theknot slider 2030. In one specific example, theknot slider 2030 is engageable in sliding contact with the suturing instrument via anarm 2034 that is receivable within an opening/window or groove 965 [Fig. 1C ] along the side of the instrumentproximal portion 910. Theknot slider arm 2034 enables positioning of the suturing instrument along thetissue receiving gap 942 to facilitate deployment of the pre-tied knot from thesuturing instrument 900 during use. Furthermore in some examples, theknot slider arm 2034 is housed within aslider groove 2036 and comprises aninner position 2034A where it is housed within the slider groove 2036 [Fig. 8D ,Fig. 11A ]. Theknot slider arm 2034 additionally and anouter position 2034B where it extends proximally (at least partially) from the slider groove 2036 [Fig. 11B ] to allow theknot slider 2030 to be positioned over thetissue receiving gap 942. - In some examples the suture is contained within tubing mounted on the inside the
knot slider 2030. Thecartridge 2000 stores the suture limbs within theknot slider 2030 for example inside a polytetrafluoroethylene (PTFE) tube that may be coiled and mounted about aninternal post 2037 aninternal knot slider 2030x that defining a passage 2037' about it once it is press fit inside theexternal knot slider 2030y as shown inFig. 11.D The PTFE tube may allow the suture to be released with a constant and small force. In other examples, the force of the suture payout may not be constant. In some examples, a silicone O-ring provides a dampening effect on the release of the suture to achieve a smoother, more constant force of release and to retain tautness in the Suture throughout the procedure. - In some examples, as described herein above in example 3, the movement of the
suturing instrument 900 may be a relative movement with respect to thecartridge 2000, with reference now to example 4. In other words the user may move thecartridge 2000 axially over thesuturing instrument 900 in a proximal direction while the suturing instrument is held by the user in order to create a relative advancement of thesuturing instrument 900 with respect to thecartridge 2000 in order to load the suture onto thesuturing instrument 900. This may be referred to as loading of suture using pumping action. As such, the mechanism of loading of the suture may remain as described above but the movement may be created either by the proximal movement of the cartridge over the suturing instrument or the distal movement of the suturing instrument within the cartridge. - In some examples as described herein, the cartridge is configured to align and transfer the suture upon a single linear motion of the cartridge with respect to the suturing instrument. In some such examples, an
interlock 2050 may be automatically disengaged upon alignment of the suture end within the seat with the suture passing member to enable automatic transfer of thesuture end 504 into the suture passing member (due to advancement of the base and activation/engagement of the push rod) as the housing 1010' is continued to be pulled proximally. Additionally the cartridge enables a pre-tied knot be mounted onto the suturing instrument during the same linear movement of the cartridge. The mechanism provided may be similar to the mechanism described herein above with respect to theknot slider 2030. Thus, examples may comprise a cartridge that is operable to transfer suture portion such as thesuture end 504 from theseat 1022 into thesuture passing member 930, which would allow the suturing instrument to be able to pass the suture in order to suture therewith, as well as enable a pre-tied knot to be mounted onto the suturing instrument. In some such examples, the cartridge is loaded onto thesuturing instrument 900 with a single linear movement. In some such examples a single pumping action is used involving a single linear relative movement of the cartridge onto the suturing instrument (to transfer the suture end mount the pre-tied knot) and linear movement the cartridge 2000 [in a direction opposite to the loading direction] thereafter leaving theknot slider 2030 coupled to thesuturing instrument 900 for example to mount a pre-tied knot held therein onto the suturing instrument. As such the remainder of thecartridge 2000 other than theknot slider 2030 is removed. - A further example of a side
load alignment mechanism 1100" is shown inFigs. 12A-12F . The 1121 magazine defines a button 1123 shown in its initial position 1121A [Fig. 12A ,12E ] comprising a side loading sliding seat 1122' [Fig. 12B ]. Thebase 1120 defines a magazine recess 1127 defining a magazine cavity 1127' and themagazine 1121 is moveable within the magazine recess. Initially, the instrument is advanceable into thebase recess 1025 that functions as a restraint to maintain the position of thesuturing instrument 900 as it is advanced distally within thebase 1120. Upon loading of the cartridge onto the suturing instrument the magazine [Fig. 12C ] the cavity 1127' corresponds to thetissue receiving gap 942. In other words, once thesuturing instrument 900 is advanced within thebase 1120 thetissue receiving gap 942 of thesuturing instrument 900 is positioned within the magazine cavity 1127' [As shown inFig. 12C ]. Themagazine 1121 is then moveable sideways into the magazine cavity 1127' to align the seat 1122' with respect to thesuturing instrument 900.Fig. 12D illustrates a side view of the base 1120 with the button in its depressed or second position 1121A andFig. 12E illustrates an end view of the same. - Thus as outlined herein above with reference to Examples 3 and 4, in accordance with some examples, a mechanism is provided for providing both alignment and insertion that may facilitate ease of use by reducing: the number of user steps required, requirements for user dexterity and concentration and in some examples additionally facilitates use by providing only one possible order of performing the user steps.
- In order to load suture into a surgical suturing instrument or suture passer, in accordance with some examples as outlined herein below in Examples 3 and 4, two events or functions take place: (1) alignment of the suture portion held within the cartridge with a suture receiving feature within the surgical suturing instrument or the suture passer and (2) insertion of the suture portion into the suture receiving feature within the suturing instrument or suture passer.
- Features of this example as illustrated in
Figs. 13A-13G are similar to those described earlier, for example with respect to Examples 3 and 4. In addition, Example 5 includes various alternatives to features described above and/or additional features not previously mentioned, including but not limited to: movement of the magazine, for example the rocker, alignment of the seat and/or rocker, reversibility-prevention features when suture has not been loaded, coupling of the rocker to the push-rod hub, indicator for indicating loading or transfer of suture onto the suturing instrument, interlock to prevent insertion of the suturing instrument in an incompatible orientation and features related to the knot slider. Each of these features will be presently described in greater detail with reference to the accompanying figures. - Referring initially to
Fig. 13A , acartridge 4000 is shown that is usable for loading a portion of a suture onto a suturing instrument, such assuturing instrument 900 described previously herein above. Similar to the embodiment discussed in example 4, thecartridge 4000 comprises a housing 4010' that comprises a housing sleeve 4011' and a knot deployment mechanism such as aknot slider 4030, with the housing 4010' defining achamber 4010 for axially receiving thesurgical suturing instrument 900 therein and a means for securing or mounting a pre-tied knot 502 (Figure 13B ) about thechamber 4010. In some examples, the knot deployment mechanism orknot slider 4030 is detachably coupled to the cartridge housing sleeve 4011' by a coupling mechanism comprising a knotslider release mechanism 4060 as shown. - The
cartridge 4000 as shown inFig. 13B defines a path for insertion of thesuturing instrument 900 within thecartridge 4000 and to facilitate removal of thesuturing instrument 900 therefrom. In one such example, the path comprises a linear path and may be partially defined by thechamber 4010. Thecartridge 4000 additionally comprises amagazine 4021 which defines aseat 4022 for releasably holding a portion of a suture. Themagazine 4021 comprises arocker 4041 as shown inFig. 13B .Rocker 4041 is similar to therocker 1041 illustrated in Example 4; significantly, however, unlike examples described previously hereinabove, the embodiment of the cartridge shown in Figure 33B lacks a base and therocker 4041 is held directly within the cartridge housing 4010' and is directly coupled to the housing 4010'. In addition,cartridge 4000 includes atranslation mechanism 4085 for movingrocker 4041 andseat 4022 in a controlled and constrained manner. In the context of the present disclosure, a translation mechanism is a feature or component that allows for movement, including but not limited to linear or rotational movement. Thetranslation mechanism 4085 allows for theseat 4022 to move out of the path of thesuturing instrument 900 for withdrawal of thesuturing instrument 900 from thecartridge 4000. In addition, thetranslation mechanism 4085 enables movement of therocker 4041 to move theseat 4022 into alignment with thesuturing instrument 900 upon advancement of thesuturing instrument 900 within thecartridge 4000. Thesuturing instrument 900 may be of the type described previously herein above with reference toFigs. 1C-1E , where the instrument comprises aproximal portion 910, and adistal portion 920 coupled thereto with atissue receiving gap 942 defined there-between for receiving a tissue to be sutured. When used with such a suturing instrument, thetranslation mechanism 4085 enables movement ofseat 4022 into and out of thetissue receiving gap 942 to allow for alignment of the seat with the suturing instrument and withdrawal of the suturing instrument, respectively. - In the particular example shown, as further illustrated in
Figs. 13C-13F , thetranslation mechanism 4085 comprises a rotational mechanism. Alternatively, in other examples, for example as shown previously inFigs. 4A-4C , the translation mechanism may comprise a spring biased mechanism operable for linear movement. In one example of a rotational translation mechanism, the rotational translation mechanism includes anarcuate track 4080 defined by the cartridge housing 4010', and one or more laterally extendingpins 4082 defined by therocker 4041 that are receivable within thetrack 4080. More specifically, in such an embodiment, the housing sleeve 4011' of the cartridge housing 4010' includes a groove ortrack 4080 formed byribs 4081, that defines a curved path, i.e. a path where at least a portion is curved. When assembled, thetrack 4080 receives rocker pins 4046' and functions to allow therocker 4041 to rotate in a pivoting manner while remaining constrained by thetrack 4080 within the housing 4010'. In such an embodiment, the rotational translation mechanism 4045 allows therocker 4041 to move between afirst position 4041A, as shown inFig. 13B andFig. 18F , for positioning theseat 4022 out of the path of the suturing instrument, and asecond position 4041B, as shown inFig. 18C (i) andFig. 18D(ii) , for positioning theseat 4022 in alignment with a portion of thesuturing instrument 900, such as the instrumentproximal portion 910. More specifically, therocker 4041 is moveable from itsfirst position 4041A shown inFig. 18Ai ), 18Aii) where theseat 4022 positioned out of the path of thesuturing instrument 900, into itssecond position 4041B where the seat is in alignment with thesuturing instrument 900 and positioned within thetissue receiving gap 942 as shown inFigs. 18Ci ), 18Cii).Figs. 18Bi) and 18Bii ) indicate the position of therocker 4041 in its intermediate position as it moves from itsfirst position 4041A towards itssecond position 4041B.Figs. 18Aii ) and18Bii ) and 18Cii) illustrate the position of therocker 4041 and thesuturing instrument 900 in isolation from the remainder of thecartridge 4000 in order to provide additional clarity. Therocker 4041 further allows theseat 4022 to be moved out of the path of thesuturing instrument 900 after the suture portion has been transferred to thesuturing instrument 900. More specifically, therocker 4041 is pivotable from itssecond position 4041B to itsfirst position 4041A to allow theseat 4022 to be moved out of thetissue receiving gap 942 of thesuturing instrument 900 to allow retraction of thesuturing instrument 900 as shown inFigs. 18E and 18F . Referring now toFigures 13C ā 13E, in the illustrated embodiment,rocker 4041 includes a resilient member or flex-arm 4031 that is operable to engage with the cartridge housing 4010', for example with a locking rib 4031' within the housing sleeve 4011'.Resilient member 4031, in cooperation with locking rib 4031', thus functions to maintainrocker 4041 in a desired initial orfirst position 4041A which facilitates unimpeded advancement of thesuturing instrument 900. Movement of therocker 4041 is otherwise similar to that ofrocker 1041 described herein with respect toFigs. 9A [i]-9B [ii] . - As shown in
Fig. 13G , which illustrates a partial cut-away view of therocker 4041 along a longitudinal axis of the rocker, with a left side portion of therocker 4041 being visible. Therocker 4041 defines a first ordistal bevel face 4043 facing towards the interior of arocker groove 4044, and more specifically defines a distal wall of the groovedistal portion 4048, similar tobevel face 1043 discussed previously hereinabove with reference toFig.9A (i) . In some examples, the distal portion ofsuturing instrument 900 is configured to interact with thefirst bevel face 4043 upon advancement of thesuturing instrument 900 within thecartridge 4000 as shown inFigs 18Ai ), 18Aii) which illustrate therocker 4041 in a partial breakaway view with therocker 4041 being shown in . This results in pivoting of therocker 4041 from itsfirst position 4041A illustrated inFigs. 18Ai ), 18Aii) into itssecond position 4041B illustrated inFigs 18Ci ), 18Cii) , and consequently results in movement of theseat 4022 into thetissue receiving gap 942, to align theseat 4022 with theproximal portion 910 of thesuturing instrument 900. In addition, therocker 4041 defines a second or proximal bevel face similar to bevel face 1043' shown in the embodiment illustrated inFig. 10B , which faces towards the interior of therocker groove 4044, and more specifically defines a proximal wall of the groovedistal portion 4048. The second bevel face is formed in a right side portion of the rocker 4041 [not visible inFig. 13G ]. In some examples, thedistal portion 920 ofsuturing instrument 900 is configured to interact with the second bevel face upon retraction of thesuturing instrument 900 from thecartridge 4000. This results in pivoting of therocker 4041 and consequent movement of theseat 4022 out of thetissue receiving gap 942 and back into itsfirst position 4041A, whereby the seat is moved out of the path of thesuturing instrument 900, as illustrated inFigs.18E and 18F . - Referring now to
Fig. 13B-13G , general alignment concepts are shown as they relate to the alignment of therocker 4041 and thus theseat 4022 with respect to thesuturing instrument 900. Thecartridge 4000 comprises several alignment features to facilitate alignment of theseat 4022 with a portion of thesuturing instrument 900 to permit transfer of a suture portion held within theseat 4022 onto thesuturing instrument 900. In one particular example, the alignment feature comprises an instrument guiding feature to guide the suturing instrument within thecartridge 4000. In some examples, the instrument guiding feature is defined by themagazine 4021 such as therocker 4041. In one such example, the instrument guiding feature comprises one orresilient members 4035 that extend from themagazine 4021. In one particular example, the one or moreresilient members 4035 comprise one or more horizontally aligningside arms 4037 for aligning the suturing instrument horizontally with theseat 4022. Theside arms 4037 guide the shaft or instrumentproximal portion 910 of thesuturing instrument 900 up toseat 4022 such that the seat cavity or recess 4022' defined by theseat 4022, is horizontally or laterally aligned with the instrumentproximal portion 910. In the particular example shown inFig. 13G , the horizontally aligningside arms 4037 extend from therocker 4041 such that they straddle thesuturing instrument 900 along its sides upon insertion of thesuturing instrument 900 within thecartridge 4000. Additionally, in some examples, as shown for example inFigs. 13H-13J , therocker 4041 may comprise the one or moreresilient members 4035 that comprise one or more vertically aligningside arms 4039 for aligning the suturing instrument vertically with the seat. In one such example, the one ormore side arms 4039 comprise a downwardly extending flex arm for engaging an upper surface of thesuturing instrument 900. As such, either or both of the horizontally aligningside arms 4037 and vertically aligningside arms 4039 enable alignment of the suture passing member such as needle 930' and thesuture receiving recess 932 defined thereby, with the seat cavity or recess 4022' which is moveable into thetissue receiving gap 942 of thesuturing instrument 900 as shown inFig. 13B . - In alternative examples, as shown in
Figs. 13H to 13J , the one or more horizontally aligningside arms 4037 may comprise an alternate configuration. In one such example, theside arms 4037A are shown that extend from an upper surface or top portion 4041t of therocker 4041. In one such example theside arm 4037A defines a slot s for routing and guiding suture to the side of therocker 4041. In another example,side arms 4037B are provided that extend distally from a front orproximal face 4041p of therocker 4041, as shown inFig. 13I . Alternatively, in some examples, the one ormore side arms 4037C may extend proximally from anintermediate portion 4041i of therocker 4041 that is positioned distal to theproximal face 4041p of therocker 4041, as shown inFig. 13J . Furthermore, as shown inFigs. 13H to 13J , in some examples the one ormore side arms gap 4041g. - In other examples, the instrument guiding feature is defined by the cartridge housing 4010'. In one such example, as shown in
Figs. 13B and13F , the instrument guiding feature comprises guidingribs 4036 within the housing sleeve 4011' of cartridge housing 4010'. Thesuturing instrument 900 is guided and constrained by ribs within the cartridge housing 4010'. The guidingribs 4036 may be provided such that they accommodate suturinginstruments 900 of varying surfaces flatness and may additionally help prevent binding of the suture. The guidingribs 4036 function to guide thesuturing instrument 900 into alignment with therocker 4041. In some examples thecartridge 4000 additionally comprises a suture guiding or routing feature to allow the suture to be routed within thecartridge 4000. In one such example, the suture guiding feature is also defined by the guidingribs 4036. The guidingribs 4036 provide clearance for the suture to run from (in some examples, a pre-tied knot mounted on) theknot slider 4030 to therocker 4041. - In other examples, as shown in
Fig. 13D , additional instrument guiding features are defined by themagazine 4021/rocker 4041. For example, therocker 4041 defines alocking recess 4044 for receiving a portion of thesuturing instrument 900 in press-fit engagement for aligning the seat with the portion of the suturing instrument. Thelocking recess 4044 is defined by the edge 4044'. Similar to examples discussed previously herein above with reference toFig. 3H to Fig. 3K , themagazine 4021 comprises a projection 4030' defining theseat 4022, as shown inFig. 13G . In one such example, the projection 4030' comprises one ormore reference features 4045a for engaging with an interior of a portion of thesuturing instrument 900 for aligning theseat 4022 with the portion of thesuturing instrument 900. - In addition to comprising instrument guiding features, referring again to
Fig. 13G , therocker 4041 additionally defines achannel 4053 in communication with theseat 4022 for allowing movement of a push rod 4053' there-through for advancing a suture end from theseat 4022 into thesuturing instrument 900. Furthermore, in some examples as shown inFigs. 13K and 13L , therocker 4041 comprises lateral halves 4041h1, 4041h2 that are configured to co-operatively engage with one another to form therocker 4041. In some such examples as shown, the lateral halves 4041h1, 4041h2 engage one another via a snap fit orpress fit mechanism 4050. As illustrated thesnap fit mechanism 4050 comprises atab 4052 that is receivable within anopening 4051 to be engaged there-with. - Alternative examples of the
rocker 4041 are shown inFigs. 14A-14G . In one particular embodiment as shown inFig. 14A , theseat 4022 comprises a seat cavity or seat recess 4022' that is defined by therocker 4041, where the seat cavity or seat recess 4022' is in communication with thewire channel 4053 and extends from thewire channel 4053. In an alternate embodiment, theseat 4022 is defined by atubular member 4022a, as shown inFig. 14B , that defines anaperture 4022a' that is in communication with thewire channel 4053.Fig. 14C illustrates a further alternative embodiment, whereintubular member 4022a comprises asleeve 4022b that can be inserted within therocker 4041 to form theseat 4022. Thesleeve 4022b defines anopening 4023 in order to provide strain relief to allow it to bend without constricting the inner tube diameter and thus it provides flexibility within the tubular member for ease of insertion and assembly of theseat 4022 within therocker 4041. - In some examples, as shown for example in
Fig. 13G , therocker 4041 comprises arocker body 4041b and aninsert 4041n defining theseat 4022. Theinsert 4041n defines a wall or median 4047 that allows a portion of the suturing instrument to rest there-against to facilitate alignment, with the instrumentdistal portion 920 being received in adistal groove portion 4048, theproximal portion 910 being received in aproximal groove portion 4046 and theseat 4022 being positioned within thetissue receiving gap 942, as shown inFig. 18C(i) . In alternate examples, as shown for example inFig. 14D , theinsert 4041n defines arocker recess 4024 for receiving a portion 4024' of therocker body 4041b therein for securing theinsert 4041n within therocker body 4041b. In some such examples, theseat insert 4041n comprises a single unit that is receivable within therocker 4041. In other examples, theinsert 4041n further comprises ahub 4025 that is coupled to a tubular member defining theseat 4022 using a coupling mechanism. In one such example, as shown inFigs. 14E and14F , the tubular member may comprise atubular member 4022a similar to the embodiment illustrated inFig. 14B . In other examples, as shown inFig. 14G , the tubular member may comprise asleeve 4022b of the type shown inFig. 14C that is coupled to thehub 4025, with thesleeve 4022b comprising a cut-out or notch/opening 4023 to provide feature for the glue to adhere to, whereas the opening withinsleeve 4022b that opens into thechannel 4053 provides clearance for a push rod to enter thesleeve 4022b. - In some examples, the
seat 4022 and thehub 4025 each comprise a polymer. In one specific example, the polymer comprises Acrylonitrile butadiene styrene (ABS). In some such examples, the coupling mechanism for coupling the hub and the tubular member comprises a polymer weld. Alternatively, theseat 4022 and thehub 4025 may each comprise a metal such as stainless steel, wherein the coupling mechanism may comprise a metal weld such as a laser weld for example as illustrated inFig. 14F . In other examples, the coupling mechanism may comprise an adhesive 4028 such as glue, as shown inFigs. 14E and14G . In some examples, for example in any of the examples shown inFigs. 14A-14G , the wire channel 4053 (not labeled in all figures) in conjunction with the seat cavity 4022' comprises a substantially s-shaped configuration. - In further examples, additional features are provided in a
cartridge 4000 for facilitating loading of suture onto asuturing instrument 900. For example, as shown inFigs. 15Ai) to 15Ciii ), thecartridge 4000 additionally comprises aninstrument retention mechanism 4070 that is configured to permit advancement of asuturing instrument 900 into thecartridge 4000 and to prevent premature retraction or withdrawal there-from until the suture portion is loaded onto thesuturing instrument 900. In some examples, theinstrument retention mechanism 4070 comprises a lock such as a biased locking element 4072' that is moveable away from or out of the path of the advancingsuturing instrument 900 to allow substantially unimpeded advancement of thesuturing instrument 900 within thecartridge 4000.Figs. 15Ai) through 15Aiii ) illustrate the locking element 4072' in its initial position prior to advancement of the instrument within the cartridge.Figs. 15Bi) through 15Biii) illustrate the locking element 4072' moved out of the path of the instrument as the instrument is advanced. In one such example, the biased locking element 4072' comprises a resilient member that flexes, bends or otherwise moves out of the way of the advancingsuturing instrument 900 to allow thedistal portion 920 of thesuturing instrument 900 to advance past the biased locking element 4072'. In some examples, for example as illustrated inFigs. 15Ci) through 15Ciii ), once thedistal tip 920 and thetissue receiving gap 942 advance past the biased locking element 4072', the biased locking element 4072' is configured to engage theproximal portion 910 of thesuturing instrument 900, specifically a window or groove 955 of thesuturing instrument 900 to thereby substantially prevent, obstruct or limit retraction of thesuturing instrument 900 prior to loading of suture onto thesuturing instrument 900. - In some such examples, a lock release mechanism is provided in order to disengage the lock. For example, a lock release mechanism is provided that may be manually operable to disengage the biased locking element 4072' from the window or
groove 955. In other examples, a lock release mechanism is provided that is configured to automatically disengage the lock upon transfer or loading of the suture portion onto thesuturing instrument 900. In some such examples, for example as shown inFig. 15Ai ), the lock release mechanism comprises a spring biased component such as arelease arm 4076 that is coupled to abiasing mechanism 4090. Thebiasing mechanism 4090 is operable to move therelease arm 4076 upon transfer of the suture portion to disengage locking element 4072' from thesuturing instrument 900. - In a specific example shown in
Figs. 16A-16D , a biased locking element is provided that comprises arotational locking mechanism 4074, wherein therotational locking mechanism 4074 comprises arotatable swing arm 4075, terminating in atab 4075t. In one such example, therotatable swing arm 4075 is biased via a torsion spring. In the illustrated embodiment, theswing arm 4075 is moveable out of the way or path (as illustrated in the dashed outline provided inFig. 16B ) of thesuturing instrument 900 in order to allow advancement of thesuturing instrument 900 within the cartridge. In some such examples,tab 4075t defines a beveled surface. In use, once the distal portion and the tissue receiving gap of thesuturing instrument 900 are positioned distal of thetab 4075t, theswing arm 4075 is moved into the path of thesuturing instrument 900 such thattab 4075t engages with the window orgroove 955. Arelease arm 4076 is moveable adjacent theswing arm 4075 to prevent rotation thereof for maintaining the tab within the groove orwindow 955. As such, theswing arm 4075 functions to lock thesuturing instrument 900 within the cartridge to prevent retraction or withdrawal of thesuturing instrument 900 prior to loading of the suture onto thesuturing instrument 900. As shown inFig. 16C , therelease arm 4076 is then translatable or moveable away from theswing arm 4075 to allow rotation thereof to permit disengagement of the tab from thesuturing instrument 900 to permit retraction and removal of thesuturing instrument 900 from the cartridge. Alternatively, the lock may comprise a resilient member biased for engaging with thesuturing instrument 900 and the release arm may be operable to allow disengagement of the resilient member from the suturing instrument. - In a further alternative as shown in
Figs. 17A-17C(ii) , the lock comprises aresilient member 4079 such as a resilient arm for engaging with thesuturing instrument 900 for example with the window or groove 955 of thesuturing instrument 900. Furthermore, alock release mechanism 4077 is provided for disengaging themember 4079 upon transfer of the suture portion onto thesuturing instrument 900. Thelock release mechanism 4077 comprises a spring biased block 4079' that in its initial position 4079'A (Fig. 17A ) supports theresilient member 4079 and prevents its movement in the proximal direction. As theinstrument 900 is advanced distally through the cartridge, theresilient member 4079 flexes to allow thedistal portion 920 of thesuturing instrument 900 to advance, as shown inFig. 17A , andresilient member 4079 is thereafter engageable with thewindow 955 of thesuturing instrument 900 to prevent retraction of thesuturing instrument 900, as shown inFigs 17B (i), 17B (ii) . The block 4079' remains in its initial or locked position 4079'A substantially adjacent theresilient member 4079 to prevent bending of theresilient member 4079 in the proximal direction to prevent retraction of thesuturing instrument 900 prior to loading of suture onto thesuturing instrument 900. Once a suture portion has been loaded onto thesuturing instrument 900, the spring biased block 4079', forming thelock release mechanism 4077, moves into its second or unlocked position 4079'B, as shown inFigs. 17C(i), 17c(ii) , where it no longer interferes with the movement of theresilient member 4079 allowing it to flex proximally, thereby permitting retraction of thesuturing instrument 900. - In some examples, the cartridge includes a delay mechanism to delay transfer of the suture from the cartridge onto the suturing instrument until after the seat, defined by the rocker,is aligned with the
suturing instrument 900. More specifically, the delay mechanism prevents actuation of the suture insertion mechanism to transfer the suture from the seat to the instrument prior to alignment of the seat with the suture passing member held within the proximal portion of the suturing instrument. - As outlined previously hereinabove, in some examples, the
distal portion 920 ofsuturing instrument 900 is configured to interact with a bevel face of the rocker such as thefirst bevel face 4043 ofrocker 4041 upon advancement of thesuturing instrument 900 within thecartridge 4000 as shown, for example, inFigs 18Ai ), 18Aii). Therocker 4041 inFigs 188Ai)-18Bii) is shown in a partial breakaway view with the front half of therocker 4041 being removed. This results in pivoting of therocker 4041 from itsfirst position 4041A, illustrated inFigs. 18Ai ), 18Aii), into itssecond position 4041B illustrated inFigs 18Ci ), 18Cii), resulting in movement of theseat 4022 into thetissue receiving gap 942 to align theseat 4022 with theproximal portion 910 of the suturing instrument 900 (specifically with a suture passing member such as needle 930'). An intermediate position of therocker 4041 is illustrated inFigs. 18Bi ), 18Bii) during movement of therocker 4041 from thefirst position 4041A towards itssecond position 4041B. - Upon movement of the
seat 4022 into thetissue receiving gap 942, thesuturing instrument 900 is advanced distally in order to allow for the needle 930' to be positioned or docked adjacent theseat 4022, for example in abutting contact with theseat 4022 as shown inFig. 18Cii ). Thus, the difference between thecartridge 4000 as shown inFigs. 18Ci) and 18Cii ) is that inFig. 18Ci ) the needle 930' and theseat 4022 are at the point at which they are aligned but not yet docked, whereas inFig. 18Cii ) thesuturing instrument 900 has been advanced further to allow the needle 930' to dock with theseat 4022. In some examples, the suture transfer or insertion mechanism is delayed until such alignment occurs, and is then actuatable to transfer or load the suture portion from theseat 4022 onto thesuturing instrument 900. In some such examples, the delay mechanism for delaying actuation of the suture insertion mechanism comprises adelay interlock 4095 mounted on the suture insertion mechanism which, in the illustrated example, comprises a push rod hub 4057' coupled to apush rod 4053, as shown inFigs. 13C and 13D . In one specific embodiment, thedelay interlock 4095 comprises aresilient member 4096 coupled to or integral with the push rod hub 4057', the resilient member 4096 (such as a push rod hub flex arm) being configured to co-operatively engage aprotrusion 4097 coupled to the rocker 4041 ((Also shown inFig. 13C andFig. 18C(ii) ), whereby theprotrusion 4097 can be understood to be indirectly coupled to the seat 4022). As shown inFig. 18Cii ), theresilient member 4096 is positioned distal to theprotrusion 4097 in a first, or unactuated, state of the suture insertion mechanism. Once theseat 4022 is aligned with the needle 930' and in abutting contact with the needle 930', as shown inFig. 18D(i) , thesuturing instrument 900 may be advanced distally within thecartridge 4000, causing the push rod hub 4057' to contact aspring hub 4100 and to thereby apply a force to hub 4100 (and, consequently, to spring 4103) as theinstrument 900 is further advanced. Once sufficient force is applied by the push rod hub 4057', as shown inFig. 18D(ii) ,spring hub 4100 is pushed distally andprotrusion 4097 is advanced beyondresilient member 4096, such thatresilient member 4096 is positioned proximal to theprotrusion 4097. The suture insertion mechanism is now in its second or actuated state resulting in the push rod hub 4057' moving within the pushrod hub cavity 4057 shown inFig. 13.G due to the biasing force ofspring 4103 againsthub 4100. Movement of the push rod hub 4057' then results in translation of the push rod 4053' coupled thereto to advance the suture portion, such as asuture end 502 comprising compressed suture, from theseat 4022 into or onto the needle 930'. Thus, in such examples, actuation of the suture insertion mechanism, and consequent transfer of the suture, is delayed until the delay interlock is positioned appropriately, which occurs following alignment of the seat with the needle 930'. - Some examples additionally comprise one or more features to provide the user with an indication that the suture portion, such as the suture end 502 [shown, for example, in
Fig. 13G ] has been transferred from theseat 4022 onto thesuturing instrument 900. In some such examples, thecartridge 4000 comprises an indicator for indicating transfer of the suture onto thesuturing instrument 900. The indicator may comprise one or more of a tactile indicator, a visual indicator or an audible indicator. In one such example, the indicator comprises a tactile indicator comprising aforce release mechanism 4200 as shown inFigs. 18D(i) and 18D(ii) . In the illustrated embodiment, aforce release mechanism 4200 comprises a spring biased mechanism defined by thespring hub 4100 which itself comprises outwardly extendinghub flex arms 4102 as well as aspring 4103. Theforce release mechanism 4200 provides an indication of a change in a force, which may be felt by the user, between the unactuated state of the suture insertion mechanism and the actuated state of the suture insertion mechanism as discussed hereinabove. More specifically, theforce release mechanism 4200 is configured such that the user is able to feel a change in force once the push rod hub 4057' moves from its initial unactuated position shown inFig. 18D(i) towards its actuated position as shown inFig. 18D(ii) for transferring the suture portion from theseat 4022 into the needle 930'. - In some examples, after transfer of the suture portion to the suturing instrument, the
suturing instrument 900 is operable to be advanced distally. As illustrated inFigs. 18D(i) and 18D(ii) , further advancement causes the outwardly extendinghub flex arms 4102 of thespring hub 4100 advance beyond ledges or ribs 4102' defined by the cartridge housing 4010' causing thespring 4103 to compress. The movement of thehub flex arms 4102 beyond the ledges 4102', combined with the concurrent compression of thespring 4103, results in a force differential that is felt by the user handling theinstrument 900, as there is a reduction in resistance force upon further advancement of thesuturing instrument 900. This reduction in force provided by the force release mechanism provides the user with a tactile feel indicating that the suture portion has been transferred onto thesuturing instrument 900. Furthermore, in some examples theforce release mechanism 4200 additionally provides an audible indication as thehub flex arms 4102 ride over the ledges 4102', whereby the force release mechanism additionally defines a snap release mechanism. In the illustrated embodiment, the tactile and/or audible indicators are not activated immediately upon transfer of the suture portion; rather, the indication is delayed until the instrument is further advanced within the cartridge. In such examples, thecartridge 4000 comprises a delay mechanism to delay activation of the indicator (for example for a predetermined time period) following loading of the suture portion from the cartridge onto thesuturing instrument 900. This provides a safety and security feature in terms of ensuring that the suture has been loaded prior to an indication being provided to the user to indicate transfer of the suture portion. In other words the indication provides a safety factor to account for dimensional and force variabitlity. - In additional examples, a visual indicator is provided, comprising a
button 4106 including a spring biased mechanism 4106'. In the illustrated embodiment, the spring biased mechanism is configured to cause thebutton 4106 to be released, allowing it to move from itsinitial position 4106A [Fig. 18C (ii) ] to itssecond position 4106B [Fig. 18D(ii) ], upon transfer of the suture portion onto thesuturing instrument 900, thereby providing a visual indication of the suture transfer. In some examples, thevisual indicator 4106 cooperates with theforce release mechanism 4200, wherebyvisual indicator 4106 is released into itssecond position 4106B upon movement of theforce release mechanism 4200. For example, as illustrated inFigs. 18D(i) and 18D(ii) , distal movement of theforce release mechanism 4200 causeshorizontal bars 4107' and 4107 coupled to thespring hub 4100 to move longitudinally, thereby releasing abar 4108 coupled to thebutton 4106 and freeing thebutton 4106 to move upwards to itssecond position 4106B. Thus, in the illustrated embodiment, the indicator is automatically activated upon loading of the suture portion from the cartridge onto the suturing instrument. In one such example, theindicator button 4106 additionally provides an audible indication to the user as thebar 4108 is released from engagement with horizontal bar 4107'. In some such examples, theindicator button 4106 may form the primary mechanism for providing an audible indication. - Once the indictor is activated the suturing instrument may then be removed from the cartridge housing as shown in
Figs. 18E and 18F . As discussed previously hereinabove, therocker 4041 enables unimpeded retraction of the suturing instrument by being made to pivot out of the way of thesuturing instrument 900 to return to itsinitial position 4041A. Theseat 4022 is moveable out of thetissue receiving gap 942 of thesuturing instrument 900. - Referring still to the embodiment disclosed in
Figs. 18E and 18F , acartridge 4000 is provided that additionally allows for loading a pre-tied knot onto asuturing instrument 900, for example by allowing loading, mounting or transfer of a knot deployment mechanism orknot slider 4030 onto thesuturing instrument 900. In some such examples, as thesuturing instrument 900 is retracted from thecartridge 4000 after loading of the suture portion onto thesuturing instrument 900, the cartridge additionally provides for a knot deployment mechanism or knot slider 4030 (that for example has a pre-tied knot mounted there-about) to be mounted onto thesuturing instrument 900 to enable retraction of the knot deployment mechanism orknot slider 4030 along withsuturing instrument 900. In one such example as shown inFig. 13B , the knot deployment mechanism orknot slider 4030 is detachably coupled to the cartridge housing sleeve 4011' by a knotslider release mechanism 4060. In one such example, the knot slider release mechanism comprises a resilient member, for example asnap arm 4062, as shown, where the resilient member is configured to release theknot slider 4030 from the housing sleeve 4011' of the cartridge housing 4010' upon insertion of asuturing instrument 900 there-through. In one such example, theknot slider 4030 and the cartridge housing sleeve 4011' together form the cartridge housing 4010'. Thesnap arm 4062 provides flexibility and allows theknot slider 4030 to pivot up and down and bend left and right as thesuturing instrument 900 is advanced through an opening or chamber within theknot slider 4030 and is guided into ribs defined by the cartridge housing sleeve 4011' to be guided into therocker 4041. In one such example theknot slider 4030 is releasable from thesnap arm 4062 upon advancement of thesuturing instrument 900 within the cartridge. For example, as shown inFig. 18C (i) , theknot slider 4030 is releasable from thesnap arm 4062 upon alignment of theseat 4022 within thetissue receiving gap 942 of thesuturing instrument 900. As such, theknot slider 4030 is decoupled from the housing sleeve 4011' and remains mounted on the suturing instrument to enable theknot slider 4030 to be retracted along with thesuturing instrument 900. - In some examples, for example as shown in
Figs. 19A to 19B , the knot deployment mechanism orknot slider 4030 additionally comprises a feature for reducing the risk of insertion of thesuturing instrument 900 by the user in an upside-down, or inverted, configuration. In some such examples, theknot slider 4030 comprises an instrument obstructing feature such as an interlock 4020' comprising anarm 4020 having aclosed configuration 4020A and anopen configuration 4020B. Theinterlock arm 4020 is configured to be initially in theclosed configuration 4020A for preventing advancement of aninverted suturing instrument 900 into the cartridge [such ascartridge 4000 disclosed herein above]. As illustrated inFig. 19C , as thesuturing instrument 900 is advanced in its inverted configuration into thecartridge 4000 through theknot slider 4030, the interlock 4020' such as theinterlock arm 4020 remains in itsclosed configuration 4020A preventing further advancement of thesuturing instrument 900 within thecartridge 4000. More specifically, the interlock 4020' is configured to engage with the flat face 921 of thesuturing instrument 900. The flat face 921 of the suturing instrument does not cooperate with theinterlock arm 4020 in a manner which allows theinterlock arm 4020 to move into its second oropen position 4020B. As such, theinterlock arm 4020 remains in itsclosed configuration 4020A impeding advancement of theinverted suturing instrument 900. - Furthermore, the interlock 4020' such as the
interlock arm 4020 is operable to permit advancement of thesuturing instrument 900 when it is advanced in its regular or nominal configuration with theinstrument 900 being positioned in the right-side up configuration, as shown inFig. 19A . As shown inFig. 19B , as thesuturing instrument 900 is advanced further through theknot slider 4030, thedistal portion 910 of thesuturing instrument 900 engages with theinterlock arm 4020, thereby moving it into itsopen configuration 4020B allowing further advancement of thesuturing instrument 900 within thecartridge 4000. More specifically, theinterlock arm 4020 is configured to engage with the bevel face 923 of thesuturing instrument 900 to cause theinterlock arm 4020 to move into theopen configuration 4020B. In some examples, the obstructing feature, such as an interlock 4020', is defined by theknot slider 4030. In alternate examples, acartridge 4000 is provided where the interlock 4020' is defined by and forms a part of the cartridge housing sleeve 4011' instead of the knot slider 4030 [e.g. as shown inFigs. 21C and 21D ]. In one such example as shown inFig. 21C the interlock arm 4020' is formed integrally with the housing sleeve 4011'. Alternatively, the interlock arm 4020' may be detachably coupled to the housing sleeve 4011' via a press-fit engagement therewith, for example as shown inFig. 21D . In some examples, for example as shown inFigs. 19A-19C , theinterlock arm 4020 comprises a pivoting connection forming a pivot arm. In some such examples, the pivot arm is held in frictional engagement with a portion of theknot slider 4030, such as theexternal knot slider 4010y of the cartridge housing 4010'. The pivot arm is operable to maintainclosed configuration 4020A by, for example, acomponent 5000, as shown inFig. 21E . In some examples, the component may comprise an elastomeric gasket such as an O-ring. - . In other examples as shown in
Figs. 21A (i)-21B (ii) the obstructing feature defines an obstruction feature resilient member, i.e. an alternative embodiment to aninterlock arm 4020.Figs. 21A(i) and 21A(ii) illustrate the alternate interlock arm in its initialclosed position 4020A, whereasFigs. 21B(i), 21B(ii) illustrate thealternate interlock arm 4020 in its second oropen position 4020B. In the illustrated embodiment, the interlock 4020' such asinterlock arm 4020 is configured to co-operate with alock 4040 within thecartridge 4000 which hold theinterlock arm 4020 in itsopen configuration 4020B to allow theinterlock arm 4020 to remain in theopen configuration 4020B. This may reducing friction that may resulting from theinterlock arm 4020 pressing against thesuturing instrument 900, when theknot slider 4030 slides along thesuturing instrument 900 during the procedure. In some such examples, thelock 4040 comprises a friction-fit mechanism comprising resilient friction tabs 4040'. Thelock 4040 comprising resilient tabs 4040' is further illustrated inFigs. 20A and 20B which shows an interlock 4020' comprising abutton 4020" . Thebutton 4020" is moveable from its firstclosed configuration 4020"A shown inFig. 20A , to its secondopen configuration 4020"B, shown InFig. 20B , upon advancement of thesuturing instrument 900 in its nominal or right side up configuration, within the cartridge. Thebutton 4020" is then held in its secondopen position 4020"B by the resilient tabs 4040'. In some examples, thebutton 4020" may be spring-biased. - In some examples, the
knot slider 4030, once mounted on thesuturing instrument 900, is operable to be releasably coupled to a handle of the suturing instrument.Knot slider 4030 is further releasable therefrom to slide distally along the instrumentproximal portion 910 during use to enable the pre-tied knot mounted about theknot slider 4030 to be deployed therefrom. In some examples, theknot slider 4030 comprises an attachment mechanism for slidably engaging with thesuturing instrument 900. In one specific example, as shown inFig. 22A , the attachment mechanism comprises a tail hook orknot slider arm 4034 is slidable along a portion of thesuturing instrument 900 such as thewindow 965 of thesuturing instrument 900. In one such example, theknot slider arm 4034 is received within a groove within an inner slider 4030x (that is held within the outer slider 4030y) and slidable therein to be extendable therefrom. Theknot slider arm 4034 is initially in its retractedconfiguration 4034A as shown inFig. 22A , where it is held within theknot slider 4030. Theknot slider arm 4034 is slidable to move into its extended position 4034B and extends out from theknot slider 4030, as shown inFig. 22C , and engages with a distal wall 965' of thewindow 965 to stop theknot slider 4030 such that it is positioned over thetissue receiving gap 942. In some such examples, theknot slider 4030 comprises a cover arm 4038 and slidableknot slider arm 4034 engages the distal wall 965' to allow the cover arm 4038 be positioned over thetissue receiving gap 942 to allow the cover arm 4038 to deflect inwards to deploy the pre-tied knot distal to thesuturing instrument 900, as illustrated inFig. 22D . In some examples as shown inFig. 22E , adistal portion 4034d of the tail kook is relatively thinner than a proximal portion 4034p of theknot slider arm 4034 so that it minimizes the risk of theknot slider am 4034 interfering with thesuturing instrument 900 upon advancement of thesuturing instrument 900 within theknot slider 4030. In some such examples, the proximal portion 4034p is wider than thedistal portion 4034d to facilitate engagement of theknot slider arm 4034 with thesuturing instrument 900. In some such examples, the inner sliderFig. 22B of theknot slider 4030 comprises a suture housing 4067' for storing suture. In one such example the suture housing comprises tubing that is wound about a portion of the knot slider such as a slidercentral post 4067. Thecentral post 4067 defines a groove 4067' for holding the suture tube. In some such examples the tubing comprises PTFE (Polytetrafluoroethylene) such as TEFLONĀ®. - In some such examples, as shown in
Fig. 22F as outlined previously herein-above, theknot slider 4030 defines achannel 4014 for receiving thesuturing instrument 900 therein. In some such examples, the inner slider 4030x of theknot slider 4030 comprises a suspension spring such as a circumferential O-ring mounted about thechannel 4014 in order to facilitate movement of theknot slider 4030 along thesuturing instrument 900. In a specific example, the O-ring comprises silicone. The O-ring provides shock absorption along the top and bottom of thesuturing instrument 900 and facilitates sliding of theknot slider 4030 by decreasing the overall sliding force by allowing thesuturing instrument 900 to be in sliding contact with the O-ring. As such the O-ring allows for easier deployment force and reduces the force of sliding and further allows the movement of theknot slider 4030 to be more tolerant and less sensitive to bumps. - Example 5 thus includes various alternatives to features described above and/or additional features not previously mentioned including but not limited to: movement of the magazine, for example the rocker, alignment of the seat and/or rocker, reversibility-prevention features when suture has not been loaded, coupling of the rocker to the push-rod hub, indicator for indicating loading or transfer of suture onto the suturing instrument, interlock to prevent insertion of the suturing instrument in an incompatible orientation and features related to the knot slider.
- In additional examples, as shown for example in
Fig. 23A , acartridge 6000 is provided having a housing 6010' for loading suture onto asuturing instrument 900 comprising a suture passing member such as needle for example that is held within the deviceproximal portion 910. Thecartridge 6000 comprises amagazine 6041 defining aseat 6022 for holding an end of the suture. Theseat 6022 is structured and configured to allow a suture passing member such as a needle to be advanced over the suture end to capture the suture end. In the illustrated embodiment as shown inFigs. 23B(i) and 23B(ii) , themagazine 6041 is moveable from thefirst position 6041A into itssecond position 6041B as shown inFigs 23C(i) and 23C(ii) in order to align theseat 6022 within thetissue receiving gap 942 of thesuturing instrument 900. Theseat 6022 is moveable into alignment with the suture passing member held within the deviceproximal portion 910. In the specific example shown, theseat 6022 is laterally moveable with themagazine 6041 being pivotable to move theseat 6022 into alignment with the suture passing member. As such themagazine 6041 defines an alignment feature for aligning theseat 6022 with the suture passing member upon insertion of a suturing instrument within thecartridge 6000. In the specific example shown, as the suturing instrument is advanced within thecartridge 6000, thedistal tip 920 of thesuturing instrument 900 moves aseat interlock 6044 which for example comprises a pin which prevents movement of theseat 6022 prior to insertion of thesuturing instrument 900 within the cartridge 6000 [Fig. 23B(i), Fig. 23B(ii) ]. More specifically, as thesuturing instrument 900 is advanced, thedistal portion 920 of the suturing instrument moves theseat interlock 6044 distally which releases themagazine 6041 causing it to pivot into itssecond position 6041B [Fig. 23C(i), Fig. 23C(ii) ]. As such theseat interlock 6044 is configured to be automatically disengaged upon advancement of thesuturing instrument 900 within thecartridge 6000 to allow theseat 6022 to be automatically brought into alignment with the suture passing member 930' upon disengagement of theseat interlock 6044. In some such examples as shown inFig. 23D , theseat 6022 comprises aseat block 6024 defines a seat cavity 6022' for holding thesuture end 502 in frictional engagement therein, as shown inFig. 23D . The seat comprises aseat post 6026 adjacent the seat cavity 6022' for retaining thesuture end 502 upon advancement of the suturing instrument within the cartridge. Theseat block 6024 is operable to be moved away from the suture passing member such as the needle 930' upon advancement of the needle 930' for example upon partial actuation of the trigger of thesuturing instrument 900, to allow capture of the suture end by the needle 930', as shown inFig. 23E . Theseat post 6026 functions to keep thesuture end 502 in place by preventing thesuture end 502 to be moved distally as theseat block 6024 is moved as shown inFig. 23E . - In some such examples, the
seat 6022 defines arecess 6028 adjacent the seat cavity 6022' for receiving the suture passing member 930', as shown inFig. 23D . In some such examples therecess 6028 defines a bevel face configured for abutment with a bevel face of the suture passing member such as needle 930'. As the needle 930' is then retracted thesuture end 502 held therein is moved along with the needle 930' into the deviceproximal portion 910. As shown inFig. 23G , thesuturing instrument 900 is then retracted with thedistal portion 920 of thesuturing instrument 900 interacting with abevel 6045 of the magazine causing it to move into itsfirst position 6041A allowing thesuturing instrument 900 to be retracted. In some such examples, the cartridge may comprise an alignment mechanism described inFigs. 12A-12F . - In some examples, one or more of the
seat 6022 and the cartridge housing comprise a medical grade polymer such as ABS. Alternatively the cartridge comprises a medical grade metal. In one example theseat 6022 comprises a metal such as stainless steel. - In alternative examples, as shown in
Figs. 24A(i), 24A(ii) , the cartridge 700o comprises a pivotingmagazine 7021 that comprises twoarms arms 7042 defining theseat 7022. As the instrument is inserted within thecartridge 7000 as shown inFig. 24A(i) ,, it pushesarm 7041 out of the way to swingarm 7042 within the tissue receiving gap of thesuturing instrument 900 to align theseat 7022 with thesuturing instrument 900, as shown inFig. 24A(ii) . Similarly,Figs. 24B(i) and 24B(ii) illustrate acartridge 7000 with a pivotingmagazine 7021. With reference toFig. 24B(iii) , thecartridge 7000 additionally comprises an outer sleeve 7000' that is moveable distally such thatbevel 7001 pushes theseat 7022 to pivot it within thetissue receiving gap 942. Once the outer sleeve 7000' is pulled proximally thebevel 7002 engagesarm 7041 to pivot themagazine 7021 to move theseat 7022 out of thetissue receiving gap 942. In additional alternatives, as shown inFigs. 24C(i), (ii) , acartridge 8000 is provided that comprises acam 8041 that is moveable to move aseat 8022 within thetissue receiving gap 942. - As such Example 6 includes various alternatives to features described above and/or additional features not previously mentioned including but not limited to: movement of the magazine, alignment of the seat and/or magazine, specifically mechanisms to enable movement of the magazine to align the seat within the tissue receiving gap of the suturing instrument, and additionally one or more examples of a cartridge that are configured to allow a suture passing member of a suturing instrument to capture an end of the suture.
- In order to load suture into a surgical suturing instrument or suture passer, in accordance with some examples as outlined hereinabove regarding Examples 3 and 4, two events or functions typically occur: (1) alignment of the suture portion held within the cartridge with a suture receiving feature within the surgical suturing instrument or the suture passer and (2) insertion or transfer of the suture portion into the suture receiving feature within the suturing instrument or suture passer.
- In some examples, a cartridge configuration is provided that is fully automated - requiring a single "pump-action" user step while completing all mechanical events to load the suture into the suturing instrument. In one such example, a user step to actuate the suture passer trigger to load the suture may not be required.
- In addition, the suture cartridge device includes a pre-tied knot and integrated features to store the Suture limbs, which may reduce the required user attention to manage the Suture and may help eliminate the complex knottying step required by existing devices. In some such examples, a cartridge configuration is provided that contains a detachable knot slider containing a pre-tied knot and storage of the suture.
- In some examples the cartridge has a side slot for securing the Suture out of the way of the suture passer shaft when it is inserted into the cartridge.
- In some such examples, the cartridge may be constructed of Medical Grade plastic/metal components such as ABS for the cartridge base, seat, suture lock, interlocks and other mechanical components. In some examples, stainless steel may be utilized for the seat, silicone in O-rings for holding the Suture. In some examples the suture contained in the cartridge may comprise polyethylene.
- Furthermore, examples as outlined herein allow the suture end to be positioned or constrained in the following degrees for alignment to occur in order to allow the suture to be loaded onto the suturing instrument. The suture portion is positioned such that it position is maintained along the X axis (lateral direction), Y-axis (vertical or up and down directions), Z axis (linear or longitudinal direction) as well along the Y- rotational axis and the Z rotational axis. Further details of the alignment mechanism are provided herein below.
- In some examples, in order to align the suture with a suture receiving feature of the suture passer (such as suture receiving passage within suture passing member a magazine defining a seat is provided that is operable to be mechanically interlocked with the suture passer such that when the suture cartridge is inserted over the suture passer and pressed, the magazine and thus the seat is configured to rotate down, aligning the suture portion within the seat with the suture passer. In some such examples the magazine defining the seat, grabs onto the suture passer to align the suture portion in the X-axis and Y-axis and constrain X-rotation and Y-rotation of the Suture. Furthermore, the seat mates with and is pushed up to the suture passer to align the suture in the Z-axis.
- In some examples, as outlined in examples 3 and 4, the magazine comprises a feature to hold/lock the suture to the side and align it with the suture slot in the suture passer shaft. In some examples as outlined above in examples 3 and 4, a cartridge base interlock is provided in the form of a button that the user presses to allow the cartridge base to move. Furthermore, some examples provide a a suture lock using which the suture is manually unlocked by the user at a specified time.
- In some examples as described herein above with reference to examples 3 and 4, examples provide an alignment mechanism that comprises a magazine defining a seat that automatically pivots into place from the top to align the suture with the suture passer. The magazine is mechanically interlocked with the suture passer such that when the cartridge containing the magazine that defines the seat, is inserted onto the suture passer, the geometry of the suture passer presses a bevel on the magazine and causes the magazine and thus the seat defined thereby, to pivot into place. In one such example the seat is a part of a rocker as outlined in further detail herein above as discussed in examples 3 and 4.
- In some examples aligning of the seat using a pivoting rocker is beneficial when the suture passer has complex features around the site at which the suture is loaded (or otherwise) limiting the alignment of the seat to be purely linear. As well, the rocker is beneficial when an automatic (without desire of user interaction to align the seat) mechanism is desired. This is because it may generally be easier to move a pivoting part through a desired displacement on an arc than a sliding part through a desired displacement along an axis. (this is due to reduced friction/binding and increased mechanical advantaged gained in a pivoting system).
- In some examples the seat is configured such that it is defined by a tubular member (seat defining member or projection) that extends out from the body of the magazine such as the rocker and is receivable into the hole on the suture passer and up against the feature in the suture passer (such as the suture passing member such as the needle) into which the suture is loaded. The projection that extends into the hole in the suture passer has an interference fit with the inner walls of the hole to align the seat/suture within a repeatable tolerance zone relative to the feature on the suture passer that receives the suture. Having this interference fit may reduce the tolerance stack-up of misalignment.
- In some examples the magazine is configured such that the magazine and thus the seat defined thereby aligns perfectly with the corresponding features on the suture passer such that the mechanism cannot possibly ever jam because the geometry does not allow that to happen.
- In some examples, the magazine is configured such that it has an interference fit with reference features on the suture passer to positively align the seat defining member or projection within a repeatable tolerance zone relative to the hole that contains the suture passing member such as the needle on the suture passer. Having this interference fit may reduce the tolerance stack-up of misalignment.
- In some examples, an alternative seat is provided, the seat containing a cavity that has an interference fit with the outer diameter of the needle. As described previously, the needle is then held in the "out" position during shipping with a lock such as cam lock that hooks the needle, or a trigger lock that hold the trigger slightly depressed. In a manual version, the user is required to press the trigger to cause the needle to move out and into the seat cavity before the suture is pulled. In some such examples, having the "Needle-out" configuration may have a reduced tolerance stackup of misalignment compared to the "Needle-In" configuration.
- In further examples, as an alternative to a top-pivoting magazine, some examples may provide a seat that pivots inwardly from the side. Alternatively, a seat may be provided that slides from the side(s) or from the top. Furthermore, instead of an automatic alignment seat, a magazine may be provided that is pushed into place by the user at a specified time to push the seat into place. Furthermore, in some examples where the magazine comprises a rocker as described above, a button may be pressed to enable the rocker to rotate.
- In some examples, the alignment feature comprises a moveable seat as outlined above. In some such examples the seat is moveable relative to the base. In other examples the seat is moveable relative to the chamber defined by the housing of the cartridge. In such examples, the seat may be automatically moveable (upon advancement of the suturing instrument within the cartridge).
- In alternative examples a fully automatic mechanism is provided for aligning and transferring suture. In other examples, a more simplified mechanical design may be provided that reduces the number of steps that the user is required perform in order to load the suture. In some examples, the mechanical design provides one or more steps that the user is required to perform to load the suture.
- In alternative examples, with reference to example 4, a push rod interlock may be provided in the form of a button that the user presses in order to allow the push rod to move to push the suture end into the suturing instrument.
- In some examples as described herein above with reference to example 4, the embodiment provides for automatic decoupling of the knot slider. In alternative examples, the Knot Slider may be manually decoupled from the Cartridge Base by the user at a specified time. In some such examples a visual indicator window may be provided that shows the user when the Lobster has been loaded and when the suture Knot Slider can be released. In some examples, with reference now to example 3, a similar mechanism in the form of a visual indicator window may be provided that shows the user when the Lobster has been loaded and when the suture lock may be released.
- In some examples a cartridge is provided that provides an additional means for providing an indication for when the suture has been loaded into the suture passing member. In some such examples, an interlock in the seat, i.e. a seat interlock may be provided which senses when the suture has left the seat. Alternatively the cartridge may provide clear or see-through components so the user can physically see when the Suture has been loaded. Furthermore, in still a further alternative, optical sensors may be provided that detect when the suture has been loaded.
- In still some additional examples, with reference to example 4, instead of a sliding tail hook on the knot slider a fixed tail hook may be provided.
- Referring again to various examples provided hereinabove, including but not limited to examples 2, 3 and 4, examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge defining a path for insertion thereto and withdrawal therefrom of the suturing instrument, the cartridge comprising:a seat for releasably holding a portion of a suture; and a translation mechanism for moving the seat out of a path of a suturing instrument inserted into the cartridge to allow for withdrawal of the suturing instrument from the cartridge. Thus, such examples provide a cartridge operable to move the seat out of the way of the suturing instrument following loading of the suture so that the suturing instrument can be withdrawn. In some such examples, the seat is moveable to align with a portion of the suturing instrument to allow for loading of the suture, such that the seat is moveable between: a first state whereby it is not obstructing a path of the suturing instrument to permit insertion of the suturing instrument into the cartridge; a second state in which the seat is moved into alignment with a portion of the suturing instrument, such as a tissue receiving gap described above, to allow for loading the suture portion onto the suturing instrument; and a third state whereby the seat is moved out of the path of the suturing instrument to permit substantially unobstructed withdrawal of the suturing instrument from the cartridge.
- As described hereinabove, some embodiment of a cartridge include a magazine comprising the seat. In some such examples, movement of the magazine, and thereby the seat, between the various states may be accomplished via a rotational mechanism (such as in examples 9 and 10 where the magazine comprises a rocker) or the movement may be accomplished via a linear mechanism such as a spring biased mechanism, for example as illustrated in Example 2 above.
- In accordance with a broad example a method is provided for loading a suture onto a surgical suturing instrument, the suture comprising suture loops and terminating in a suture end. The method involves mounting the suture loops onto a surgical suturing instrument positioned through the suture loops. The suture end is aligned with the suture receiving passage of the suture passing member and suture end is transferred to the suture receiving passage of the suture passing member. The step of aligning the suture end may involve restraining the suturing instrument with respect to the suture end. The suture end may be aligned by moving the suture end with respect to the suturing passing member. In some examples, the step of aligning the suture end may comprise moving the suture passing member with respect to the suture end. In some examples the method of loading the suture onto the suturing instrument is performed using a suture loading apparatus such as a cartridge. The cartridge may be used to both mount suture loops onto the surgical instrument and to align the suture end with the suture receiving passage of the suture passing member.
- In a general example, which is not part of the invention, a method is provided for suturing within an inter-vertebral disc. The method involves using a cartridge to load suture onto a suturing instrument, and then using the surgical suturing instrument to deliver the suture into the inter-vertebral disc. In some examples, the cartridge is used to load suture at the point of use, for example by a physician just prior to using the suturing instrument within a patient. In a specific example of the method, the suturing instrument is used to pass or insert suture into a region of tissue surrounding a defect within the inter-vertebral disc and approximating the defect using the suture. In an instant of this example, approximating the defect involves forming a loop of suture around the defect using the suture to provide a 360 degree approximation of the defect. After the suture is used to approximate the defect a means is provided to secure the suture within the inter-vertebral disc such as knot. In some examples, the knot comprises a pre-tied knot and is deployed after the step of approximating the defect. In a particular example the cartridge provides a pre-tied knot.
- In some examples the method of loading the suture onto the suturing instrument is performed using a suture loading apparatus such as a cartridge. More specifically with reference now to
Figs. 1A-1F , acartridge 100 is provided for loadingsuture 500 onto thesuturing instrument 900. Thesuture 500 comprises suture loops orpre-tied knot 502 that opens into aservice loop 501 comprising atug loop 507 that terminates in thesuture end 504 held within theseat 122. Referring now to Fig. IF, thedistal tip 920 ofsuturing instrument 900 is inserted the housing 10' through thechannel 14 within thechamber 10, such that it is positioned through the suture loops orpre-tied knot 502 mounted on the housing 10'. Thedistal tip 920 of thesuturing instrument 900 is then advanced distally through and past thechannel 14 so that the housing 10' is now mounted onto the proximal portion orshaft 910 of the suturing instrument. Since thebase 120 is flexibly coupled viaflexible tube 152 to the housing 10', this allows thecartridge base 120 to be positioned to the side and out of the way (away from the longitudinal axis of the suturing instrument 900) to permit thesuturing instrument 900 to be advanced. Theflexible tube 152 bends to allow thecartridge base 120 to be kept off to the side from the path of thesurgical suturing instrument 900 as it is advanced through the housing 10'. Thesuturing instrument 900 is positioned such that thedistal tip 920 and theneck portion 940 as well as thetissue receiving gap 942, are positioned distal to the housing 10'. - The
cartridge base 120 is then moved back towards the longitudinal axis of thesuturing instrument 900 to be clipped into thesurgical suturing instrument 900. In the example illustrated inFig. 1A-1F , therestraint 25 comprises alocking recess 125 that corresponds to the shape of thesuturing instrument 900. Specifically it is a recess that is shaped to accommodate theneck portion 940, and a segment of the proximal anddistal portions suturing instrument 900. Referring again to Fig. IF, thecartridge base 120 is then snapped to thesuturing instrument 900. The suturing instrument 900is received within thelocking recess 125 such that the base 120 press-fits around it. Thelocking recess 125 functions to restrain the suturing instrument to help align theseat 122 and thus thesuture end 504 held within the with theseat 122 with thesuture receiving passage 932 of thesuturing instrument 900. - As outlined previously, the
cartridge base 120 additionally comprises analignment recess 130 adjacent theseat 122 to further assist in aligning theseat 122 with thesuture receiving passage 932 of thesuturing instrument 900. Thealignment recess 130 is dimensioned to receive thesuture passing member 930 such as needle 930'. Once the movement of thesuturing instrument 900 is constrained or restricted by the lockingrecess 125, the needle 930' is advanced (for example by actuating a trigger) within thealignment recess 130 such that the needle 930' is positioned adjacent theseat 122. - As mentioned previously, the suture is routed through the
base slot 128 that is in communication with theseat 122, as shown inFig. 1B . Once thesuturing instrument 900 is inserted within the locking recess 125 (in the position shown in Fig. IF), thebase slot 128 is aligned with thelongitudinal opening 928 within the instrumentproximal portion 910 and with theslit 938 within the needle 930'. Thesuture tug loop 507 that exits thecartridge 100 is then pulled (proximally) by tugging on it for to draw thesuture end 504 from theseat 122 and into the alignedsuture receiving passage 932 of thesuture passing member 930 to position thesuture end 504 therein. As thetug loop 507 is pulled, thesuture retention pin 165 holds a portion of thetug loop 507 to prevent theservice loop 501 from being pulled out of thesuture spool 160. The suture retaining component165 may then be removed, releasing thesuture 500. In one specific example where the trigger is actuated to advance the needle 930' within the recess, the trigger may be released at this point. Once,suture end 504 is loaded onto thesuturing instrument 900, the cartridge housing 10' is then advanced proximally along the instrument proximal portion orshaft 910, for example till the handle of thesuturing instrument 900 and coupled there. Once the housing 10' is advanced proximally theflexible tube 152 is detached from the housing 10', decoupling the base 120 from the housing' 10'. Thecartridge base 120 can be removed from the suturing instrument by unsnapping thecartridge base 120 from thesurgical suturing instrument 900. More specifically, thesuturing instrument 900 is decoupled from the lockingrecess 125 of thebase 120. - The
suturing instrument 900 is then used to passsuture 500 through a region of tissue for example within an intervertebral disc of a patient's body to apply suture thereto, for example to close a defect within the inter-vertebral disc. As thesuture 500 is passed through the inter-vertebral disc, thesuturing instrument 900 is then pulled such that thesuture 500 held within suture storage such assuture spool 160 is payed out. The tension within thesuture 500 then decouples the housing 10' from the instrument proximal portion orshaft 910, allowing the housing 10' to slide distally along thesuturing instrument 900 and deploy thepre-tied knot 502 within the inter-vertebral disc to secure thesuture 500 passed through the disc. - The
cartridge base 220 may be removed from the surgical instrument and discarded. - In accordance with an alternate example, a method is provided for loading
suture 500 onto thesuturing instrument 900 using acartridge 400, as shown inFigs. 2A-2C . The cartridge comprises a housing 10' (for example of the type previously described) that is detachably coupled to thebase 420. The cartridge is loaded onto thesuturing instrument 900 by advancing theinstrument 900 through the housing 10' and then through the instrument receiving recess 425' within thecartridge base 420 with the spring mounted magazine 421 (or interlock 421') being initially positioned in its first orinitial position 421A, as shown inFig. 4B . In some examples, thecartridge 400 axially receives (or in other words permits axial advancement of) a portion of asuturing instrument 900 relative to the base in order to load the suture onto thesuturing instrument 900. In other words, thecartridge 400 permits loading suture onto thesurgical instrument 900 by allowing thesurgical instrument 900 to be received axially through the cartridge 400.For example thesuturing instrument 900 may be advanced distally through thecartridge 400 or thecartridge 400 may be moved proximally along the suturing instrument). In one example, the method provides for front end loading of the suturing instrument 900' using thecartridge 400. - In a particular example, as the
instrument 900 is advanced distally through thecartridge base 420, a tapered section of thedistal tip 920 engages a slant or incline 923 of the interlock 421' automatically moving the magazine 421 (and thus the seat 422) downwards and into thetissue receiving gap 942 of thesuturing instrument 900 to align the seat 422 (and thesuture end 504 held therein) with thesuture receiving passage 932, as illustrated inFig. 2C . The spring mounted magazine 421 (or interlock 421') is now positioned in its second position 421B. The movement of themagazine 421 into thetissue receiving gap 942, and the distal advancement of thesuturing instrument 900 through themagazine 421, further functions as a restraining feature to lock or restrain thesuturing instrument 900 with respect to thecartridge 400. In some examples thesuturing instrument 900 is slid into thecartridge 400 until it stops. - Furthermore, as the
magazine 421 moves downwards during distal advancement of thesuturing instrument 900, theprojection 430 moves into theshaft 910, such that bevel 434 of theprojection 430 abuts against theneedle bevel 934. This helps align the seat 422 (andsuture end 504 held releasably within the seat channel 424) with thesuture receiving passage 932 of thesuturing instrument 900. Thus, the magazine 321 (Fig. 2C ) is automatically moved into its second position to align theseat 422 with thesuture passing member 930 upon relative movement between thecartridge base 420 and theinstrument 900. In some examples, the housing 10' may be advanced proximally along theshaft 910 until it abuts against the instrument handle, decoupling the base 420 from the housing 910'. The base 420 can then be removed from thesuturing instrument 900. In some examples, the base 420 can be automatically detached as theinstrument 900 is withdrawn proximally andmagazine 421 moves into itsinitial position 421A. Thepre-tied knot 502 on the housing 10' may be deployed in the manner described previously for cartridge examples 100, 200. - Generally examples as outlined herein above provide a
cartridge 1000 that permits axial loading of asuturing instrument 900 for example of the type described previously herein with reference toFigs. 3A-3O . Thesuturing instrument 900 particularly provides a challenge as theinstrument 900 defines an instrumentdistal portion 920 and an instrumentproximal portion 910 defining atissue receiving gap 942 there-between, where thesuture passing member 930 that is to be loaded with suture is held within the instrumentproximal portion 910. - Thus, in order to permit axial loading of the
suturing instrument 900, thecartridge 1000 provides a means for aligning the suture with thesuture passing member 930 by allowing the suture to remain out of the way of the advancingsuturing instrument 900 to enable advancement of the instrumentdistal portion 920 without hindrance. Thus, the suture is kept out of the way of thesuturing instrument 900 until the instrumentdistal portion 920 has advanced past the suture, allowing the suture to then be moved into thetissue receiving gap 942 thereafter to align the suture with thesuture passing member 930 to transfer the suture therein. - In accordance with an example, with reference now to
Fig. 4A , a method of use of thecartridge 1000 is disclosed for facilitating loading ofsuture 500 onto asurgical suturing instrument 900, for example at the point of use. In some examples a pivotingseat 1022 such as that defined by therocker 1041 facilitates axial loading by enabling therocker 1041 to remain out of way of the path of the advancingsuturing instrument 900 until thetissue receiving gap 942 is positioned within the rocker cavity 1027'. Once thesuturing instrument 900 is in place thecartridge 1000 enables therocker 1041 to pivot down into thetissue receiving gap 942, such that theseat 1022 is positioned adjacent and aligned with thesuture passing member 930 such as a needle 930'. - As shown in
Fig. 4A , the method provides for initially positioning thesuturing instrument 900 within thecartridge 1000. Thesuturing instrument 900 is then passed axially through thecartridge 1000 to enable front end loading of thesuturing instrument 900. More specifically, With reference toFigs 4A and3C , thesuturing instrument 900 is inserted into theopening 1016 within the housing 1010' and is guided by the beveled interior edge 1016' into thechannel 1014 of the cartridge housing 1010' and advanced distally As outlined above,channel 1014 extends longitudinally through the housing 1010' and is in communication with thebase recess 1025 formed within thebase 1020, forming arestraint 25. Thus, as thesuturing instrument 900 is advanced through thecartridge 1000, it extends from thechannel 1014 into theinstrument receiving groove 1025a of therecess 1025 within thebase 1020 that is in communication with thechannel 1014. Therestraint 25 constrains or limits the movement of thesuturing instrument 900 in the transverse (i.e. up and down) and lateral directions as well along a longitudinal path defined thereby. Therestraint 25 enables thesuturing instrument 900 to be advanced in sliding engagement therein to maintain the position to thesuturing instrument 900 along a path that is in line with the final position of theseat 1022 to facilitate alignment therewith to enable transfer of suture into a portion of the suturing instrument. Thesuturing instrument 900 is then advanced further such that the distal portion or end 920 of thesuturing instrument 900 exitsrecess 1025a of thebase 1020. More specifically, in the illustrated embodiment as shown inFig. 4A , as thesuturing instrument 900 is advanced it passes through theinstrument receiving groove 1025a of the base 1020 [Shown inFig. 3E ] into therocker recess 1027 of thebase 1020, until it is received within thedistal groove portion 1048 of therocker 1041. As such thesuturing instrument 900 is positioned adjacent thesuture 500 held within thesuture groove 1025b [Also shown inFig. 3D ]. As outlined previously, thesuture 500 is held within thecartridge 1000 such that thesuture end 504 is held within theseat 1022 from where it exits into the pivot recess orcavity 1027 and is routed along thesuture groove 1025b of thebase recess 1025. - Referring again to
Fig. 4A , thedistal portion 920 of thesuturing instrument 900 is initially received within thedistal groove portion 1048 of therocker groove 1044, with therocker 1041 being in its initial orfirst position 1041A. As shown inFig. 4B , upon advancement of thesuturing instrument 900, the distal surface of thedistal tip 920 then contacts and engages thebevel surface 1043 of thegroove 1044 along the rear wall of the of thedistal groove portion 1048 The instrument distal tip engages thebevel face 1043 exerting a force there-against to enable therocker 1041 to move from its first position into itssecond position 1041B, as shown inFigs. 4C(i) ,4C(ii) and 4C(iii) . More specifically, thedistal portion 920 of thesuturing instrument 900 is advanced with a sufficient force to enable therocker 1041 to disengage from a location within therocker recess 1027 where it is held in place in itsinitial position 1041A, as shown inFig. 4A , for example by frictional engagement or a tab. - With reference again to
Fig. 4C(i) ,4C(ii), 4C(iii) , oncerocker 1041 is released from engagement, it starts to pivot down. As therocker 1041 pivots into position theproximal portion 910 of thesuturing instrument 900 is received into theproximal groove portion 1046. The pivotal movement of therocker 1041 enables thesuturing instrument 900 to be loaded axially by allowing thedistal end 920 to advance past theseat 1022 of therocker 1041 before therocker 1041 pivots down into thetissue receiving gap 942 such that theseat 1022 is now positioned within thetissue receiving gap 942 of thesuturing instrument 900. As shown inFig. 4D , thesurgical suturing instrument 900 is then continued to be advanced into thebase 1020, until thesuture passing member 930 such as the needle 930' is in abutting contact with theseat 1022. Once the needle 930' abuts theprojection 1030, it halts the movement of thesuturing instrument 900 with respect to and within thecartridge 1000. More specifically, as shown inFig. 4D and earlier with reference toFig. 3M , thebevel face 934 of the needle 930' is in abutting contact withbevel face 1034 of theprojection 1030 that defines theseat 1022 such theneedle slot 938 and the shaft slot 928 [behind the needle 930' and theprojection 1030 that forms the seat 1022] are in line with and adjacent the seat slot 1028. Theshaft slot 928 and theneedle slot 938 are visible inFigs 1D and 1E , discussed earlier. - In some examples, in order to align the suture 404 with a suture receiving feature of the suturing instrument 900 (such as
suture receiving passage 932 within suture passing member 930) a magazine in the form of arocker 1041 is provided that is operable to be mechanically interlocked with the suturing instrument such that when the suture cartridge is inserted over the suturing instrument and pressed, therocker 1041 is configured to rotate down, aligning thesuture end 504 with the suturing instrument. In some such examples therocker 1041 grabs onto thesuturing instrument 900 to align thesuture end 504 in the X-axis (laterally) and Y-axis (transverse/vertical or up and down directions and constrains the rotation the suture end in the X and Y rotational directions. Furthermore, therocker 1041 mates with and is pushed proximally up to thesuturing instrument 900 to align the Suture in the Z-axis (linear or longitudinal directions). - As outlined previously up until this point the
interlock 1050 remains in its initial lockedposition 1050A which ensures that thebase 1020 remains coupled to the housing 1010' as shown inFigs. 5A and5C As further illustrated inFig. 5B , in this position theinterlock arms 1056 are positioned axially adjacent the lockingarms 1026 of the base and prevent the movement of thebase 1020 relative to the housing 1010'. As such the lockingarms 1026 of thebase 1020 are in engagement with theinterlock arms 1056. However, one theseat 1022 and thus thesuture end 504 has been aligned with the needle 930' thecartridge 1000 enables direct transfer of thesuture end 504 into the needle 930' using the housing 1010'. In other words theseat 1022 is in alignment with and adjacent thebevel face 934 of the needle 930' the suture end held in a force fit inside theseat 1022 can then be transferred into the needle 930' (Fig. 3M and4D ). As shown inFigs. 6A and 6B , theinterlock 1050 is then moved from its lockedposition 1050A to itsunlocked position 1050B to disengage the housing 1010' [which defines asuture transferring component 1011 as discussed previously herein] from the base to transfer the suture onto thesuturing instrument 900. More specifically, the housing 1010' and as such thesuture transferring component 1011 defined thereby, is detached from thebase 1020 allowing the housing 1010' to be pulled back such that thesuture end 504 is transferred into the needle 930', as shown inFig. 7A . Thedetached base 1020 may be removed thereafter as shown. As such thecartridge 1000 of the present embodiment allows suture to be independently transferred from thecartridge 1000 into thesuture passing instrument 900. In additional examples, where suture loops that form a partially pre-tied knot may be mounted about the housing 1010', the housing 1010' additionally provides for loading a partially pre-tied knot on thesuturing instrument 900. - In some examples once the
suture end 504 has been loaded into the needle the housing 1010' may then be removed. In other examples where the housing provides a partially pre-tied knot and/or carries excess suture therein for example in a spool, the housing 1010' may remain mounted on the instrumentproximal portion 910 to retain the partially pre-tied knot and or excess suture on thesuturing instrument 900. In the embodiment illustrated inFigs 7A-7E , thesuture lock 1060 may be disengaged to allow the housing 1010' and as such thesuture transferring component 1011 defined thereby to be disengaged with thesuturing instrument 900 after thesuture end 504 has been loaded onto thesuturing instrument 900. With reference now toFigs. 7A-7B ,7E which illustrate the lock in its initial lockedconfiguration 1060A. As discussed previously, herein in the initial lockedconfiguration 1060A, thesuture 500 is routed through the suturelock engaging component 1062 of the housing 1010', and thesuture lock 1060 is press fit in the suturelock engaging component 1062 thereby pressing thesuture 500 between theteeth 1064 of thesuture lock 1060 and corresponding teeth 1064' of the suturelock engaging component 1062, and as such thesuture 500 is coupled to the housing 1010'. In order to release thelock 1060, the lock is the moved into itssecond position 1060B as shown inFigs. 7D and7F , moving theteeth 1064, 1064' out of engagement with one another and releasing the suture held therein. The housing 1010' and thus thesuture transferring component 1011, may then be removed from thesuturing instrument 900. - Thus, examples provide a
cartridge 1000 that provides a means to load suture into a suture passing instrument of the type as described herein (such as suturing instrument 900) having an instrumentproximal portion 910 and an instrumentdistal end 920 defining atissue receiving gap 942 there-between. The current embodiment additionally facilitates automatic alignment of suture 500 (forexample end 504 of the suture 500) by allowing therocker 1041 to pivot into the tissue receiving gap upon engagement with the instrumentdistal end 920 as it is being advanced into thecartridge 1000. - As such in terms of general overview of the embodiment described herein above in Example 3, in order to facilitate insertion of the suture portion held within the cartridge, alignment of the suture portion must have occurred and three basic mechanical events are configured to take place (i) an applied force on the Suture relative to the Suture Passer in one direction [for example proximally]. (ii) Relative motion between Suture and Suture Passer in the same direction (iii) Relative motion between Suture and Seat in the opposite direction.
- In some such examples, a suture cartridge is provided that that exerts a force on the end of the suture to load it into the surgical suturing instrument or the suture Passer. All mechanical events achieved by the suture cartridge device are obtained in a single "pump' action performed by the user and in some examples may not require actuation of the suture passer (suturing instrument) trigger. {In some such examples the single "pump' action maybe likened to that of a shotgun loading action.
- As such in some examples, a suture cartridge is provided that uses a pulling force on the end of the suture to load it into the suture passer as outlined in example 3 herein above. In some examples, the pull method may be used to insert suture into a suture passer that would allow space for a generally straight-line pull of the suture in the direction of loading. In some situations the pull method may be used when it is required that the suture stay managed/in tension throughout the loading procedure.
- In some examples, the seat locks onto a limb. The mechanical events to insert the suture occur in the following ways: (1) to apply the force to the end of the suture, the strand of suture is pulled in the middle by a means of grasping the strand with the Suture Lock. (2) To achieve relative motion between the suture and suture passer, the suture passer is fixed with respect to the suture, such that when the applied pulling force is exerted onto the Suture, the suture passer stays still and the suture moves towards and into the suture passer. (3_to achieve relative motion between the suture and seat (in the Suture Cartridge), the seat is also fixed with respect to the Suture, such that when the applied pulling force is exerted onto the Suture, the seat stays still and the suture moves away from and out of the seat.
- In some examples, a pull insertion mechanism is provided that has a suture lock which is a piece that can move independently from the cartridge base and the suture passer that holds the suture proximally to the seat and is moved away from the seat, thus pulling the suture and creating the required force and relative motion.
- In some examples, the suture lock automatically decouples from the cartridge base once the seat has fully aligned the suture (suture portion) with the suture passer. This is done by way of an interlock that prevents the Suture lock from moving relative to the cartridge base until the full alignment step has occurred (i.e. prevents the suture from being pulled before it is fully aligned).
- In some examples, the pull insertion mechanism comprises a suture Lock that automatically unlocks from the suture once the suture (e.g. suture end) has been successfully loaded into the suture passer. As such unlocking of the suture allows the suture passer to then pass the suture freely. In some examples, the unlocking is performed by way of an interlock which prevents unlocking to occur until the point at which the suture is successfully loaded into the suture passer. In one such example, the suture lock interlock may be force/displacement based using a spring to ensure that a given amount of force is exerted on the suture to obtain a given displacement of the suture lock. In some examples, the force may be calibrated to be much greater than the maximum theoretical/empirically derived force required to successfully load the Suture. Once this force is achieved, a certain displacement may also be achieved causing the interlock to unlock the suture.
- In some such examples, a pre-tied knot is provided on a knot slider which is integrated with a suture lock and houses the suture strands. The knot Slider remains on the suture passer after the suture cartridge is actuated to load the suture into the suture passer and functions to release the suture knot to the surgical site once the suture passer is used.
- In accordance with an example, with reference now to
Fig.9A[i]-10D[ii] , a method of use of thecartridge 2000 is disclosed for facilitating loading ofsuture 500 onto asurgical suturing instrument 900, for example at the point of use. In some examples a pivotingseat 1022 such as that defined by therocker 1041 facilitates axial loading by enabling therocker 1041 to remain out of way of the path of the advancingsuturing instrument 900 until thetissue receiving gap 942 is positioned substantially within the rocker cavity 1027'. Once thesuturing instrument 900 is in place thecartridge 1000 enables therocker 1041 to pivot down into thetissue receiving gap 942, such that theseat 1022 is positioned adjacent and aligned with thesuture passing member 930 such as a needle 930'. Thecartridge 2000 additionally provides asuture transferring component 2011 for transferring thesuture end 504 from theseat 1022 into thesuture receiving recess 932 of thesuturing instrument 900. Thecartridge 2000 additionally provides aknot slider 2030 that permits loading of apre-tied knot 502 onto thesuturing instrument 900. - In some examples, the method provides for initially positioning the
suturing instrument 900 within thecartridge 2000. The method is described in reference to the advancement of thesuturing instrument 900 within thecartridge 2000. However, in some such examples thecartridge 2000 is loaded onto thesuturing instrument 900 via a proximal movement of thecartridge 2000 over thesuturing instrument 900. As such thesuturing instrument 900 thecartridge 2000 are moveable relative to one another. - With reference now to
Fig.9A[i] , the cartridge 300 is loaded proximally over thesuturing instrument 900, with thesuturing instrument 900 being passed axially through the cartridge 3000 to enable front end loading of thesuturing instrument 900. More specifically, thesuturing instrument 900 is inserted through thechamber 1010 of the housing 1010' defined by theknot slider 2030. The suturing instrument is guided by the beveled interior edge 2016' of theopening 2016 into thechannel 2014 of the knot slider (Fig. 8D andFig.9A [iii] ), and as such mounting theknot slider 2030 and the pre-tied knot mounted onto the suturing instrument. As thesuturing instrument 900 is advanced further it is received within theinstrument receiving groove 2025a of thebase recess 2025 within thebase 2020. Thebase recess 2025 and thechannel 1014, function as therestraint 25 to constraint or limit the movement of thesuturing instrument 900 in the transverse (i.e. up and down) and lateral directions as well along a longitudinal path defined thereby. Therestraint 25 enables thesuturing instrument 900 to be advanced in sliding engagement therein to maintain the position to thesuturing instrument 900 along a path that is in line with the final position of theseat 1022 to facilitate alignment therewith to enable transfer of suture into a portion of the suturing instrument. Theinstrument receiving groove 2025a guides the suturing instrument into therocker recess 1027. As outlined previously, thesuture 500 is held within thecartridge 2000 such that thesuture end 504 is held within theseat 1022 from where it exits into the pivot recess orcavity 1027 and is routed along thesuture groove 1025b of the base recess 1025.As such thesuturing instrument 900 is positioned adjacent thesuture 500 held within thesuture groove 1025b, also shown in (Figs.8F[i], 8F[ii] ). - Referring again to
Fig.9A[i] ,[ii] , thedistal portion 920 of thesuturing instrument 900 is initially received within thedistal groove portion 1048 of therocker groove 1044, with therocker 1041 being in its initial orfirst position 1041A. Upon advancement the instrumentdistal tip 920 contacts and engages thebevel surface 1043 along the rear wall of the of thedistal groove portion 1048 exerting a force there-against to move therocker 1041 to rom itsfirst position 1041A into itssecond position 1041B, as shown inFigs.9B[i],[ii] . More specifically, thedistal portion 920 of thesuturing instrument 900 is advanced with a sufficient force to enable therocker 1041 to disengage from thefriction tab 2029 within therocker recess 1027 where it is held in place in itsinitial position 1041A, as shown inFig.9A[i] . - With reference again to
Figs. 9B[i], 9B[ii] , oncerocker 1041 is released from engagement within therocker recess 1027, it starts to pivot down into the rocker cavity 1027'. As therocker 1041 pivots into position theproximal portion 910 of thesuturing instrument 900 is received into theproximal groove portion 1046. The pivotal movement of therocker 1041 enables thesuturing instrument 900 to be loaded axially by allowing thedistal end 920 to advance past theseat 1022 of therocker 1041 before therocker 1041 pivots down into the rocker cavity 1027' that corresponds to thetissue receiving gap 942 such that theseat 1022 is now positioned within thetissue receiving gap 942 of thesuturing instrument 900. - In some examples, in order to align the
suture 504 with a suture receiving feature of the suturing instrument 900 (such assuture receiving passage 932 within suture passing member 930) a magazine in the form of arocker 1041 is provided that is operable to be mechanically interlocked with the suturing instrument such that when the suture cartridge is inserted over the suturing instrument and pressed, therocker 1041 is configured to rotate down, aligning thesuture end 504 with the suturing instrument. In some such examples therocker 1041 grabs onto thesuturing instrument 900 to align thesuture end 504 in the X-axis (laterally) and Y-axis (transverse/vertical or up and down directions and constrains the rotation the suture end in the X and Y rotational directions. Furthermore, therocker 1041 mates with and is pushed proximally up to thesuturing instrument 900 to align the suture in the Z-axis (linear or longitudinal directions). - As shown in
Fig.9B[i],[ii] , thesurgical suturing instrument 900 is then continued to be advanced into thebase 2020, upto/until thesuture passing member 930 such as the needle 930' is in abutting contact with theseat 1022. Once the needle 930' abuts theprojection 1030, it halts the movement of thesuturing instrument 900 with respect to and within thecartridge 1000. More specifically, as shown inFig. 4D and earlier with reference toFig. 3M , thebevel face 934 of the needle 930' is in abutting contact withbevel face 1034 of theprojection 1030 that defines theseat 1022 such theneedle slot 938 and the shaft slot 928 [behind the needle 930' and theprojection 1030 that forms the seat 1022] are in line with and adjacent the seat slot 1028. Theshaft slot 928 and theneedle slot 938 are visible inFigs 1D and 1E , discussed earlier. - As outlined previously up until this point the
interlock 2050 remains in its initial lockedposition 1050A which ensures that thebase 1020 remains coupled to the housing 1010' as shown inFigs. 9A[i] ,9A[ii] . As further illustrated inFigs. 9C[i], 9C[ii] , in this position theinterlock arm 2056 is positioned axially adjacent and distal to thebase 2020. The interlock arm prevents the movement of thebase 2020 relative to the housing 2010'. However, as theseat 1022 moves into the rocker cavity 1027' of the rocker recess 1027 (and thus thesuture end 504 has been aligned with the needle 930') therocker bar 2055 moves theinterlock tab 2054 adjacent the base wall 2054' to be positioned out of way of theinterlock 2050. As shown inFigs. 9D[i], 9D[ii] , theinterlock 2050 is then moved from its lockedposition 2050A to itsunlocked position 2050B to disengage the base 2020 from the housing 1010' [which defines asuture transferring component 1011 as discussed previously herein]. This allows thebase 2020 and theknot slider 2030 attached thereto to slide distally as the housing sleeve 1011' is pulled proximally (Figs. 9E[i],9E[ii] ). In the illustrated example, theinterlock 2050 is moved by the user. - Upon relative movement of the
suture transferring component 1011 proximally relative to thebase 2020, thebase 2020 moves distally and presses against thepush sleeve hub 2012 that moves distally within the sleeve cavity 2012'. As thepush sleeve hub 2012 is biased towards thebase 2020 via a spring mechanism [that comprises two springs 2013], it functions to push thepush rod hub 2057 upon translation of thesuture transferring component 2011 with respect to thebase 2020. Thepush rod hub 2057 translates proximally within push rod cavity 2057' (Figs. 9Bii ,9E[ii] ) causing the longitudinally extending wire 2053' to translate proximally within thewire channel 2053 in communication with theseat 1022 to push thesuture end 504 held within theseat 1022 into thesuture receiving passage 932 of thesuturing instrument 900. - As the
base 2020 is advanced distally, theknot slider 2030 is moveable with base 2020 theknot slider 2030 is moveable distally along theknot slider recess 2018 within the housing sleeve 2011' upon distal movement of thebase 2020 within the housing sleeve 2011'. However, the wall of the housing sleeve 1011' adjacent the tapered inner wall 2019 [Fig. 8B ] of theknot slider recess 2018 functions as a stop to prevent further distal movement of theknot slider 2030 to disengagesnap arms 2042 of the base 2020 from the snap grooves of theknot slider 2030, as shown inFig.9F . As such the knotslider release interlock 2033 is disengaged releasing theknot slider 2030. In additional examples, where suture loops that form a partially pre-tied knot may be mounted about the housing 1010', the housing 1010' additionally provides for loading a partially pre-tied knot on thesuturing instrument 900. - In some examples the suture is contained within tubing [for example inside a polytetrafluoroethylene (PTFE) tube] mounted on the inside the knot slider 2030 [
Fig. 11D ], the cartridge additionally provides for loading or mounting the suture limbs within theknot slider 2030 on thesuturing instrument 900 along with the partially pre-tied knot. - In some examples once the
suture end 504 has been loaded into the needle the housing 1010' thecartridge 2000 may then be removed and may be pulled proximally. As such in some examples thecartridge 2000 is loaded onto thesuturing instrument 900 and removed thereafter using a pumping action. The relative movement of the suturing instrument with respect to thecartridge 2000 is in a proximal direction. As thesuturing instrument 900 is pulled proximally theknot slider 2030 remains mounted thereon and is removed with the suturing instrument 900 (as shown inFig. 10A ). As thesuturing instrument 900 is retracted thedistal head 920 interacts with the bevel face 1043' of the rocker 1041 (Fig. 10B ). This enables therocker 1041 to move out from thetissue receiving gap 942 allowing thesuturing instrument 900 to be removed, without hindrance as shown inFig. 10C . - The
knot slider arm 2034 is slidable along the instrument window or groove 965 in saidinner position 2034A. Theknot slider arm 2034 may remain in itsinitial position 2034A as it is slid proximally along the instrument proximal portion orshaft 910, for example to be attached with a handle portion 960 of the instrument 900 [shown inFig. 11A ]. Once theinstrument 900 has been used to pass suture the tissue theinstrument 900 may be used thereafter to deploy thepre-tied knot 502. As theinstrument 900 is pulled back proximally after suturing theknot slider 2030 disengages from the handle portion of the suturing instrument and slides distally along the shaft proximal portion of thesuturing instrument 900. As shown inFig. 11B , as the knot slider slides distally along theshaft 910 it engages with a front wall 965'of theshaft groove 965, causing theknot slider arm 2034 to move out from theslider groove 2036 into saidexternal position 2034B to enable positioning of saidknot slider 2030 over the tissue receiving gap 942 [Fig. 11C ] such that acover arm 2038 of the knot slider is positioned over thetissue receiving gap 942. This enables deployment of the pre-tied 502 from theknot slider 2030 while maintaining engagement of theknot slider 2030 with thesuturing instrument 900 and as such prevents the pre-tied knot from falling in or getting caught in thetissue receiving gap 942. - Thus, examples additionally provide a
cartridge 2000 that provides a means to load suture into asuture passing instrument 900 of the type as described herein having an instrumentproximal portion 910 and an instrumentdistal end 920 defining atissue receiving gap 942 there-between. The current embodiment additionally facilitates automatic alignment of suture 500 (forexample end 504 of the suture 500) by allowing therocker 1041 to pivot into the tissue receiving gap upon engagement with the instrumentdistal end 920 as it is being advanced into thecartridge 1000. Furthermore,cartridge 2000 provides asuture transferring component 2011 to transfer suture into the suture passing member and additionally provides aknot slider 2030 to mount apre-tied knot 502 onto thesuturing instrument 900. - As such in terms of general overview of the embodiment described herein above in example 4, in order to facilitate insertion of the suture portion held within the cartridge, alignment of the suture portion must have occurred and three basic mechanical events are configured to take place (i) an applied force on the Suture relative to the Suture Passer in one direction [for example proximally]. (ii) Relative motion between Suture and Suture Passer in the same direction (iii) Relative motion between Suture and Seat in the opposite direction.
- In some such examples, a suture cartridge is provided that exerts a force on the end of the suture to load it into the surgical suturing instrument or the suture Passer. All mechanical events achieved by the suture cartridge device are obtained in a single "pump' action performed by the user and in some examples may not require actuation of the suture passer (suturing instrument) trigger. {In some such examples the single "pump' action maybe likened to that of a shotgun loading action.
- In some such examples, a suture cartridge is provided that uses a pushing force on the end of the suture to load it into the suture passer as outlined in example 4 herein above. In one such example the cartridge applies a direct pushing force to the suture to load it onto the suture passer.
- In some examples, the cartridge comprises a push rod which is a part of the cartridge independent from the seat and suture passer. It is a piece that exists inside the seat and upon actuation presses against the end of the suture to push it forwards in the seat.
- In some examples, the mechanical events to insert the suture occur in the following ways: (i) to apply the force to the end of the suture a flexible, moveable push rod exists in an S-shaped lumen that exists in the seat. The push rod has a tip that contacts the suture. (ii) To achieve relative motion between the suture and suture passer, the suture passer is fixed with respect to the Suture, such that when the applied pushing force is exerted onto the suture, the suture passer stays still and the suture moves towards and into the suture passer. (iii) to achieve relative motion between the suture and seat (in the suture cartridge), the seat is also fixed with respect to the push rod and suture, such that when the applied pushing force is exerted onto the suture, the seat stays still and the suture moves away from and out of the seat.
- In some examples, once insertion of the suture has been achieved, a part of the cartridge that contains the suture limbs (the knot slider) detaches from the cartridge and remains attached to the suture passer. In some examples the push method can be used when a high loading force is required.
- In some examples, the cartridge mechanism comprises a push rod that is a piece that can move independently from the cartridge base, seat and suture passer and it is a piece that exists inside the seat and upon actuation presses against the end of the suture to push it forwards in the Seat.
- In some examples, the push insertion mechanism is configured such that the push rod pushes the suture once the seat has fully aligned the Suture with the suture passer. This may be done by way of a series of interlocks that prevent the push rod from moving relative to the seat until the full alignment step has occurred (i.e. prevents the suture from being pushed before it is fully aligned). Interlocks: 1: Rocker Interlock to prevent the rocker from moving until shaft is inserted [tab or
detent 2029Fig. 8C ]. 2: Rocker Geometry: being such that it prevents seat member from contacting shaft during rocker rotation (Forexample bevel 1043 inFig.9A[i] of the rocker and its location and configuration in reference to the seat ensures that the seat does not contact the shaft as the instrument is advanced). 3: Push Rod Interlock: to prevent the push rod from moving before the seat is aligned with the needle. 5: Push Spring: in some examples the push rod is actuated with a spring (as outlined above in example 4) to ensure that a given amount of force was being exerted on the suture for a given displacement of the push rod. This force would be calibrated to be much greater than the maximum theoretical/empirically derived force required to successfully load the Suture. Once this force was achieved, a certain displacement would also be achieved and the interlock would unlock the Suture. - In some examples, as outlined previously herein above the cartridge is configured for containing a pre-tied knot on a knot slider which also houses the suture strands. The Knot Slider [for e.g. 2030 as described above) automatically detaches from the cartridge Base and remains on the suture passer after the suture cartridge is actuated. The knot slider functions to release the suture knot to the surgical site once the suture passer is used.
- In some examples interlock may be provided. For example: Knot slider release interlock (for example knot
slider release interlock 2033 as described above) which prevents the knot slider form releasing until the suture has been loaded into the needle. In some examples, there may be an additional suture retention interlock that prevents the suture limb from moving until the shaft is removed from the cartridge. - Suture Storage: As outlined previously with reference to
Fig. 11D , the cartridge in some examples stores the suture limbs within the Knot Slider inside a (polytetrafluoroethylene) PTFE tube. Furthermore, as outlined in example 4, the cartridge comprises knot slider retention features on shaft. In some examples the cartridge has a Knot Slider that contains a tail hook that retains the knot slider on the suture passer shaft at the end of the procedure. As outlined previously, the tail hook is enclosed within the knot slider and once the knot slider slides to the end of the shaft, the tail hook slides out of the knot slider and hooks onto the shaft. - Thus, as described herein above, various examples of a cartridge, and methods of use thereof, are disclosed. These examples provide a cartridge for loading suture at the point-of-use onto a surgical suturing instrument such as a suture passing instrument or suture passer, where the suturing instrument includes a suture passing member onto/into which the suture is to be loaded, and where the application requires/benefits from a pre-tied knot. In some examples a suture loading cartridge is provided with a feature for securing a pre-tied knot with the ability to deploy the pre-tied knot onto the suture passer (for example by passing the suturing instrument through a chamber of the cartridge that has the knot tied about it), as well as a second feature for aligning a suture end with the suture passing member of the suture passer to facilitate loading of the suture onto/into the suture passing member. In some examples the second feature for aligning the suture may be movable with respect to the first feature (so that the suture passer can be inserted into the cartridge through the pre-tied knot after which a suture end loaded into the cartridge can be brought into alignment with the suture passing member).
- In one broad aspect, examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge defining a path for insertion thereto and withdrawal therefrom of the suturing instrument, the cartridge comprising:a seat for releasably holding a portion of a suture; and a translation mechanism for moving the seat out of a path of a suturing instrument inserted into the cartridge to allow for withdrawal of the suturing instrument from the cartridge.
- In another broad aspect, examples provide a cartridge for loading a suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture; and an alignment feature for facilitating alignment of the seat with a suturing instrument to permit transfer of the suture portion from the seat onto the suturing instrument.
- In still an additional broad aspect, examples provide A cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for holding a portion of the suture; and an instrument retention mechanism configured to allow advancement of a suturing instrument into the cartridge and to prevent premature retraction therefrom.
- In a further broad aspect examples comprise a cartridge for loading a suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of a suture to enable transfer of the suture onto the suturing instrument; and an indicator for indicating transfer of the suture portion onto the suturing instrument.
- In still an additional embodiment, a cartridge is provided for loading suture onto a suturing instrument, the cartridge comprising: a seat for holding a portion of a suture; and an obstructing feature having a closed configuration and an open configuration, the obstructing feature being configured to be initially in the closed configuration for preventing advancement of an inverted suturing instrument into the cartridge, and to be moveable into the open configuration upon insertion of the suturing instrument into the cartridge in a nominal orientation.
- In still another broad aspect, examples provide a cartridge for loading suture onto a suturing instrument, the cartridge comprising: a seat for releasably holding a portion of the suture; an alignment feature for aligning the seat with a portion of the suturing instrument; a suture insertion mechanism that is actuatable to insert the suture portion from the seat onto the suturing instrument; and a delay interlock to prevent actuation of the suture insertion mechanism prior to alignment of the seat with the portion of the suturing instrument.
- In still another broad aspect, examples provide a cartridge for loading a pre-tied knot onto a suturing instrument, the cartridge comprising: a cartridge housing; a knot slider for carrying a pre-tied knot thereabout; and a knot slider release mechanism for detachably coupling the knot slider to the cartridge housing.
- In an additional broad aspect, examples provide a cartridge for loading suture onto a suturing instrument comprising a suture passing member, the cartridge comprising a seat for holding an end of the suture, the seat being structured and configured to allow a suture passing member to be advanced over the suture end to capture the suture end.
- The examples of the invention described above are intended to be exemplary only. The scope of the invention is therefore intended to be limited solely by the scope of the appended claims.
- It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate examples, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination.
Claims (13)
- A suturing kit, the kit comprising:at least one suturing instrument (900); andat least one cartridge (2000, 4000) for loading a suture onto the suturing instrument (900), the cartridge defining a path for insertion thereto and withdrawal therefrom of the suturing instrument (900), the cartridge comprising:a base (2020) or a magazine (4021) defining a seat (2022, 4022) for releasably holding a portion of the suture (500);an alignment feature (1041, 4041) holding the seat and adapted to align the seat with a portion of the suturing instrument (900); anda suture transfer mechanism that includes a suture transferring component that comprises a housing sleeve (2011', 4011') that is detachably coupled to the base (2020) or the magazine (4021) of the cartridge (2000) that comprises the seat (2022), the housing sleeve (2011', 4011') being configured to remain coupled to the base (2020) or the magazine (4021) until the seat (2022) is aligned with a portion of the suturing instrument (900), and being detachable from the base (2020) or the magazine (4021) thereafter to transfer the portion of the suture (500) onto the suturing instrument (900);characterized bya translation mechanism (4085) for moving the seat out of a path of the suturing instrument when inserted into the cartridge to allow for withdrawal of the suturing instrument from the cartridge, wherein the seat is moveable between:- a first state whereby it is not obstructing a path of the suturing instrument to permit insertion of the suturing instrument into the cartridge;- a second state in which the seat is moved into alignment with a portion of the suturing instrument to allow for loading the portion of the suture onto the suturing instrument; and- a third state whereby the seat is moved out of the path of the suturing instrument to permit unobstructed withdrawal of the suturing instrument from the cartridge.
- The kit of claim 1, wherein the seat is arranged to move upon advancement of the suturing instrument (900) within the cartridge (2000, 4000).
- The kit of claim 1 or 2, wherein the suture transferring component is arranged to apply a pushing force to the suture portion to transfer the suture portion from the seat into the suturing instrument in a single linear motion of the cartridge (2000, 4000) with respect to the suturing instrument (900).
- The kit of any of claims 1 to 3, wherein the base is detachably coupled to the suture transferring component via an interlock (2050), wherein the interlock comprises an automatic interlock, wherein the automatic interlock is configured to disengage the suture transferring component from the base upon alignment of the seat with the suturing instrument (900).
- The kit of any of claims 1 to 4, wherein the suture transferring component further comprises a push rod (2058, 4053), wherein the housing sleeve is arranged moveable with respect to the seat to engage the push rod to push the suture portion held within the seat to transfer it to the suturing instrument (900).
- The kit of any of claims 1 to 5, comprising a delay interlock (4095) configured to prevent actuation of the suture transfer mechanism prior to alignment of the seat with the portion of the suturing instrument (900).
- The kit of any of claims 1 to 6, wherein the suture transferring component is operable to pull a portion of the suture that is held in frictional engagement within the seat in order to transfer the suture into the suturing instrument (900).
- The kit of any of claims 1 to 7, wherein the suture transferring component is defined by a cartridge housing that is detachably coupled to the seat, the seat being secured to the housing allowing the cartridge to operate as a single functional unit upon loading of the cartridge onto the suturing instrument until the seat is aligned with the suturing instrument, the housing being translatable independently thereafter to transfer the suture portion from the seat into the suturing instrument (900).
- The kit of any of claims 1 to 8, wherein the alignment feature comprises a restraint.
- The kit of any of claims 1 to 9, wherein the alignment feature comprises a projection that defines the seat.
- The kit of any of claims 1 to 10, wherein the base (2020) or the magazine (4021) comprises a rocker (1041, 4041) defining the seat.
- The kit of any of claims 1 to 11, wherein the alignment feature comprises an instrument guiding feature to guide the suturing instrument (900) within the cartridge (2000, 4000).
- The kit of any of claims 1-12, wherein the suturing instrument (900) comprises:a proximal portion;a distal portion coupled to the proximal portion; anda tissue receiving gap defined between the proximal and distal portions for receiving a tissue to be sutured.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP21194198.4A EP3977942A1 (en) | 2013-03-15 | 2014-09-17 | Apparatus for loading suture |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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PCT/IB2014/059847 WO2014141208A1 (en) | 2013-03-15 | 2014-03-15 | Apparatus and methods for loading suture |
PCT/IB2014/064608 WO2015140606A1 (en) | 2014-03-15 | 2014-09-17 | Apparatus and methods for loading suture |
Related Child Applications (2)
Application Number | Title | Priority Date | Filing Date |
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EP21194198.4A Division EP3977942A1 (en) | 2013-03-15 | 2014-09-17 | Apparatus for loading suture |
EP21194198.4A Division-Into EP3977942A1 (en) | 2013-03-15 | 2014-09-17 | Apparatus for loading suture |
Publications (3)
Publication Number | Publication Date |
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EP3119287A1 EP3119287A1 (en) | 2017-01-25 |
EP3119287A4 EP3119287A4 (en) | 2017-11-29 |
EP3119287B1 true EP3119287B1 (en) | 2021-10-13 |
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EP14886626.2A Active EP3119287B1 (en) | 2013-03-15 | 2014-09-17 | Apparatus for loading suture |
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EP (1) | EP3119287B1 (en) |
WO (1) | WO2015140606A1 (en) |
Families Citing this family (2)
Publication number | Priority date | Publication date | Assignee | Title |
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USD790698S1 (en) | 2015-12-01 | 2017-06-27 | Anchor Orthopedics Xt Inc | Apparatus for loading suture |
CN118058787B (en) * | 2024-04-19 | 2024-08-16 | åäŗ¬čæčæŖ锶峰å»ēē§ęč”份ęéå ¬åø | Closure and knotting system |
Family Cites Families (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3901244A (en) * | 1973-05-07 | 1975-08-26 | Edward E Schweizer | Suture cartridge |
US5478345A (en) * | 1994-08-19 | 1995-12-26 | United States Surgical Corporation | Mechanism for endoscopic suturing device |
US5755729A (en) * | 1995-04-27 | 1998-05-26 | General Surgical Innovations, Inc. | Magazine for loading a needle and a length of suture onto a surgical instrument |
US5733293A (en) * | 1996-05-08 | 1998-03-31 | United States Surgical Corporation | Disposable loading unit for a vascular suturing instrument |
US5814069A (en) * | 1997-04-08 | 1998-09-29 | Ethicon Endo-Surgery, Inc. | Load assist device for a suture cartridge |
US6533796B1 (en) * | 2000-10-11 | 2003-03-18 | Lsi Solutions, Inc. | Loader for surgical suturing instrument |
US7615061B2 (en) * | 2006-02-28 | 2009-11-10 | Arthrocare Corporation | Bone anchor suture-loading system, method and apparatus |
US7875042B2 (en) * | 2007-05-04 | 2011-01-25 | Ethicon Endo-Surgery, Inc. | Suture anchor loader |
US20110082471A1 (en) * | 2009-10-06 | 2011-04-07 | Holcomb Matthew D | Reloadable Laparoscopic Fastener Deploying Device |
WO2013142487A1 (en) * | 2012-03-22 | 2013-09-26 | Cook Medical Technologies Llc | Suture cartridge and method of use thereof |
-
2014
- 2014-09-17 WO PCT/IB2014/064608 patent/WO2015140606A1/en active Application Filing
- 2014-09-17 EP EP14886626.2A patent/EP3119287B1/en active Active
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EP3119287A1 (en) | 2017-01-25 |
EP3119287A4 (en) | 2017-11-29 |
WO2015140606A1 (en) | 2015-09-24 |
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